Provider Demographics
NPI:1215297031
Name:HOVANESIAN, PAUL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:HOVANESIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-0185
Mailing Address - Country:US
Mailing Address - Phone:424-272-6452
Mailing Address - Fax:
Practice Address - Street 1:760 WESTWOOD PLZ # B8-257
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1411
Practice Address - Country:US
Practice Address - Phone:310-210-3721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-26
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29014103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical