Basic Information
| Provider Information | |||||||||
| NPI: | 1326369778 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAWALANIC | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | ERIC | ||||||||
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| Credential: | PSY.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10801 NATIONAL BLVD | ||||||||
| Address2: | SUITE 611 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900644170 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102734843 | ||||||||
| FaxNumber: | 3102735056 | ||||||||
| Practice Location | |||||||||
| Address1: | 10801 NATIONAL BLVD | ||||||||
| Address2: | SUITE 611 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900644170 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102734843 | ||||||||
| FaxNumber: | 3102735056 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2010 | ||||||||
| LastUpdateDate: | 06/07/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY28351 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.