Provider Demographics
NPI:1487138079
Name:REGA, GAYLA VANOUSH
Entity type:Individual
Prefix:MS
First Name:GAYLA
Middle Name:VANOUSH
Last Name:REGA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:GAYLA
Other - Middle Name:VANOUSH
Other - Last Name:TERZIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7462 W 80TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-6805
Mailing Address - Country:US
Mailing Address - Phone:323-841-9555
Mailing Address - Fax:
Practice Address - Street 1:7462 W 80TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-6805
Practice Address - Country:US
Practice Address - Phone:323-841-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107831106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist