Provider Demographics
NPI:1124820477
Name:AKTUTAY, ANA LUISA (PPS)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:LUISA
Last Name:AKTUTAY
Suffix:
Gender:
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18600 LANARK ST
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-1233
Mailing Address - Country:US
Mailing Address - Phone:818-882-2496
Mailing Address - Fax:
Practice Address - Street 1:18600 LANARK ST
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-1233
Practice Address - Country:US
Practice Address - Phone:818-882-2496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA200212075103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool