1497925820 NPI number — A BEAUTIFUL LIFE PSYCHOLOGY GROUP

Table of content: (NPI 1497925820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497925820 NPI number — A BEAUTIFUL LIFE PSYCHOLOGY GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A BEAUTIFUL LIFE PSYCHOLOGY GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE BELLA VITA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497925820
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
766 COLORADO BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90041-1702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-255-0400
Provider Business Mailing Address Fax Number:
323-255-0177

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22466 VENTURA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODLAND HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91364-1523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-676-1540
Provider Business Practice Location Address Fax Number:
818-676-1542
Provider Enumeration Date:
02/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
COTTON
Authorized Official First Name:
ESTHER
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
323-255-0400

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com