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General NPI Number Information
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NPI Number | 1629772223
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Entity Type | Organization
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Legal Business Name | AOSTA CLINIC INC
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Dates
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Enumeration Date | 03/28/2023
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Last Update Date | 03/28/2023
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Provider Practice Location Address
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Address Line | 800 S CENTRAL AVE STE 207
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City | GLENDALE
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State | CA
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Zip | 91204-4388
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Country | US
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Telephone | 818-395-3778
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Fax | 818-697-9099
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Provider Business Mailing Address
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Address Line | 800 S CENTRAL AVE STE 207
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City | GLENDALE
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State | CA
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Zip | 91204-4388
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Country | US
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Telephone | 818-395-3778
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Fax | 818-697-9099
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VAHE SUKIASYAN
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Credential | PSYD
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Telephone | 818-395-3778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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