Healthcare Provider Details

I. General information

NPI: 1073453775
Provider Name (Legal Business Name): PETER DYMOCK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16055 VENTURA BLVD STE 555
ENCINO CA
91436-2607
US

IV. Provider business mailing address

10907 MAGNOLIA BLVD # 1009
NORTH HOLLYWOOD CA
91601-3904
US

V. Phone/Fax

Practice location:
  • Phone: 818-533-1385
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number161527
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: