Healthcare Provider Details

I. General information

NPI: 1992011126
Provider Name (Legal Business Name): SHIRLEY IMPELLIZZERI PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9454 WILSHIRE BLVD SUITE 301
BEVERLY HILLS CA
90212-2931
US

IV. Provider business mailing address

9454 WILSHIRE BLVD SUITE 301
BEVERLY HILLS CA
90212-2931
US

V. Phone/Fax

Practice location:
  • Phone: 310-859-1102
  • Fax: 310-859-3503
Mailing address:
  • Phone: 310-859-1102
  • Fax: 310-859-3503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY17322
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: