MEDICARE: IFAT PELED PHD

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	28021	CA

General Provider Information

NPI Number	:	1144680547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IFAT PELED PHD

Provider Business Mailing Address
First Line	:	17000 VENTURA BLVD STE 317
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91316-4164
Country	:	US
Telephone Number	:	818-399-0156
Fax Number	:

Provider Business Practice Location Address
First Line	:	17000 VENTURA BLVD STE 317
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91316-4164
Country	:	US
Telephone Number	:	818-399-0156
Fax Number	:

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

Provider Enumeration Date	:	02/26/2016
Last Update Date	:	04/14/2017

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Directions to “ IFAT PELED PHD” Practice Location

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