MEDICARE: DR. AMI ISRAEL STUDENT PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	27086	CA
2	103TC0700X	Clinical Psychologist	028135	NY
3	103TC0700X	Clinical Psychologist	202862	ID
4	103TC0700X	Clinical Psychologist	3673	OR

General Provider Information

NPI Number	:	1063725794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMI ISRAEL STUDENT PSY.D.

Provider Business Mailing Address
First Line	:	42440 BOB HOPE DR SUITE 1
Second Line	:	#150
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270
Country	:	US
Telephone Number	:	213-465-0040
Fax Number	:	949-739-0225

Provider Business Practice Location Address
First Line	:	39900 DESERT SUN DR
Second Line	:
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-3607
Country	:	US
Telephone Number	:	213-465-0040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2010
Last Update Date	:	06/02/2026

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