Healthcare Provider Details

I. General information

NPI: 1720613813
Provider Name (Legal Business Name): DGAB SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6309 VAN NUYS BLVD
VAN NUYS CA
91401-6628
US

IV. Provider business mailing address

PO BOX 1763
SUN VALLEY CA
91353-1763
US

V. Phone/Fax

Practice location:
  • Phone: 818-239-9586
  • Fax:
Mailing address:
  • Phone: 818-239-9586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DIANA GABRIELIAN
Title or Position: PRESIDENT
Credential:
Phone: 818-239-9586