Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | OT18362 | CA |
NPI | 1366990871 |
---|---|
Provider Name | Meenadchi Gunanayagam |
First Address | Los Angeles, CA 90026-4641 |
Second Address | Los Angeles, CA 90035-3414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2016 |
Last Update Date | 28/05/2019 |