Healthcare Provider Details

I. General information

NPI: 1891305074
Provider Name (Legal Business Name): NEURO PSYCHOLOGY ASSESSMENT CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15720 VENTURA BLVD STE 214
ENCINO CA
91436-2954
US

IV. Provider business mailing address

838 N DOHENY DR APT 904
WEST HOLLYWOOD CA
90069-4850
US

V. Phone/Fax

Practice location:
  • Phone: 310-926-8336
  • Fax:
Mailing address:
  • Phone: 310-926-8336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. DANIEL HAI
Title or Position: CLINICAL NEUROPSYCHOLOGIST
Credential: PSY.D.
Phone: 310-926-8336