MEDICARE: SHILOH APRILIA WEST PSYD

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	103T00000X	Psychologist	PSB94022279	CA

General Provider Information

NPI Number	:	1326399452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHILOH APRILIA WEST PSYD

Provider Business Mailing Address
First Line	:	1460 7TH ST STE 300
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90401-2632
Country	:	US
Telephone Number	:	310-924-9249
Fax Number	:

Provider Business Practice Location Address
First Line	:	1460 7TH ST STE 300
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90401-2632
Country	:	US
Telephone Number	:	310-924-9249
Fax Number	:

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

Provider Enumeration Date	:	09/28/2012
Last Update Date	:	04/05/2018

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