Provider Demographics
NPI:1215271317
Name:SIMONIAN, INGA (PHD)
Entity type:Individual
Prefix:
First Name:INGA
Middle Name:
Last Name:SIMONIAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14930 VENTURA BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3487
Mailing Address - Country:US
Mailing Address - Phone:818-570-1636
Mailing Address - Fax:818-698-6974
Practice Address - Street 1:14930 VENTURA BLVD STE 230
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3487
Practice Address - Country:US
Practice Address - Phone:818-570-1636
Practice Address - Fax:818-698-6974
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25302103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1992181143Medicaid