MEDICARE: DR. BAHMAN REZAIPOUR 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	17817	CA
2	103TC0700X	Clinical Psychologist	2418	CO

General Provider Information

NPI Number	:	1447231246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BAHMAN REZAIPOUR PHD

Provider Business Mailing Address
First Line	:	PO BOX 4921
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91308-4921
Country	:	US
Telephone Number	:	310-421-8211
Fax Number	:

Provider Business Practice Location Address
First Line	:	1314 WESTWOOD BLVD
Second Line	:	UNIT 211
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-4902
Country	:	US
Telephone Number	:	310-421-8211
Fax Number	:

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

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	03/24/2014

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