Healthcare Provider Details

I. General information

NPI: 1407365604
Provider Name (Legal Business Name): ANGELA ALICE IZMIRIAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2017
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10819 NE 99TH AVE
VANCOUVER WA
98662-3439
US

IV. Provider business mailing address

10819 NE 99TH AVE
VANCOUVER WA
98662-3439
US

V. Phone/Fax

Practice location:
  • Phone: 818-437-4232
  • Fax:
Mailing address:
  • Phone: 818-437-4232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2876
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: