Healthcare Provider Details

I. General information

NPI: 1336018670
Provider Name (Legal Business Name): MEDICAL MIND HEALING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17525 VENTURA BLVD STE 203
ENCINO CA
91316-5109
US

IV. Provider business mailing address

17525 VENTURA BLVD STE 203
ENCINO CA
91316-5109
US

V. Phone/Fax

Practice location:
  • Phone: 310-271-5875
  • Fax:
Mailing address:
  • Phone: 310-271-5875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT HASHEMIYOON
Title or Position: PRESIDENT
Credential: MD
Phone: 310-271-5875