Provider Demographics
NPI:1447490958
Name:BAGOURDI, ELENI (PHD)
Entity type:Individual
Prefix:DR
First Name:ELENI
Middle Name:
Last Name:BAGOURDI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ELENA
Other - Middle Name:
Other - Last Name:BAGOURDI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2001 S BARRINGTON AVE STE 314
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5379
Mailing Address - Country:US
Mailing Address - Phone:310-999-9683
Mailing Address - Fax:
Practice Address - Street 1:2001 S BARRINGTON AVE STE 314
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5379
Practice Address - Country:US
Practice Address - Phone:310-999-9683
Practice Address - Fax:213-261-9887
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22542103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABP875AMedicare PIN