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General NPI Number Information
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NPI Number | 1164769055
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Entity Type | Individual
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Provider Name | VREZH AYRAPETYAN PH.D.
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Gender | Male
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Dates
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Enumeration Date | 01/11/2013
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Last Update Date | 01/11/2013
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Provider Practice Location Address
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Address Line | 401 N BRAND BLVD SUITE 822
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City | GLENDALE
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State | CA
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Zip | 91203-4427
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Country | US
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Telephone | 818-480-5779
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5783 APT # 9
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City | GLENDALE
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State | CA
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Zip | 91221
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Country | US
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Telephone | 818-621-7587
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY 24470
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License Number State | CA
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