Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY-26390 | CA |
Y | 103T00000X | Psychologist | PSY-26390 | CA |
NPI | 1003129362 |
---|---|
Provider Name | Dr. Mina Grigoryan |
First Address | Glendale, CA 91205 |
Second Address | South Pasadena, CA 91030-2610 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2010 |
Last Update Date | 17/03/2018 |