MEDICARE: DR. AFSANEH MATLOOB 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	PSY21145	CA

General Provider Information

NPI Number	:	1558486118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AFSANEH MATLOOB PSY.D.

Provider Business Mailing Address
First Line	:	1293 S BEVERLY GLEN BLVD APT 308
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-5252
Country	:	US
Telephone Number	:	310-701-0157
Fax Number	:

Provider Business Practice Location Address
First Line	:	1293 S BEVERLY GLEN BLVD APT 308
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-5252
Country	:	US
Telephone Number	:	310-701-0157
Fax Number	:

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	11/10/2022

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