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General NPI Number Information
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NPI Number | 1639799406
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Entity Type | Individual
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Provider Name | JOSEPH AGUAYO PH.D
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Gender | Male
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Dates
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Enumeration Date | 04/22/2020
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Last Update Date | 04/22/2020
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Provider Practice Location Address
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Address Line | 11849 W OLYMPIC BLVD STE 202
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City | LOS ANGELES
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State | CA
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Zip | 90064-1148
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Country | US
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Telephone | 310-478-7636
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Fax |
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Provider Business Mailing Address
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Address Line | 8420 KIRKWOOD DR
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City | LOS ANGELES
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State | CA
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Zip | 90046-1928
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Country | US
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Telephone | 323-481-3745
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY8389
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License Number State | CA
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