Healthcare Provider Details

I. General information

NPI: 1851644538
Provider Name (Legal Business Name): RIANA LEAKE CHAGOURY M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15030 7TH ST
VICTORVILLE CA
92395-3811
US

IV. Provider business mailing address

1625 SCHRADER BLVD
LOS ANGELES CA
90028-6213
US

V. Phone/Fax

Practice location:
  • Phone: 833-438-8763
  • Fax: 833-438-8700
Mailing address:
  • Phone: 323-860-5844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number32343
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: