MEDICARE: ANA LUISA AKTUTAY PPS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist	200212075	CA

General Provider Information

NPI Number	:	1124820477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA LUISA AKTUTAY PPS

Provider Business Mailing Address
First Line	:	18600 LANARK ST
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335-1233
Country	:	US
Telephone Number	:	818-882-2496
Fax Number	:

Provider Business Practice Location Address
First Line	:	18600 LANARK ST
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335-1233
Country	:	US
Telephone Number	:	818-882-2496
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2025
Last Update Date	:	03/26/2025

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Directions to “ ANA LUISA AKTUTAY PPS” Practice Location

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