Provider Demographics
NPI:1215173406
Name:GABRIELIAN, SONYA EMI (MD, MPH)
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:EMI
Last Name:GABRIELIAN
Suffix:
Gender:F
Credentials:MD, MPH
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11301 WILSHIRE BLVD
Mailing Address - Street 2:WEST LA VA, MIRECC BLDG 210A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90073-1003
Mailing Address - Country:US
Mailing Address - Phone:310-478-3711
Mailing Address - Fax:310-268-4056
Practice Address - Street 1:11301 WILSHIRE BLVD
Practice Address - Street 2:WEST LA VA, MIRECC BLDG 210A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073-1003
Practice Address - Country:US
Practice Address - Phone:310-478-3711
Practice Address - Fax:310-268-4056
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA1062842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFE755ZMedicare PIN