Healthcare Provider Details

I. General information

NPI: 1235556739
Provider Name (Legal Business Name): SANDRA LABEEB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2014
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date: 12/27/2016
Reactivation Date: 07/06/2018

III. Provider practice location address

3580 WILSHIRE BLVD STE 2000
LOS ANGELES CA
90010
US

IV. Provider business mailing address

3580 WILSHIRE BLVD STE 2000
LOS ANGELES CA
90010-2533
US

V. Phone/Fax

Practice location:
  • Phone: 213-381-1250
  • Fax: 213-383-4803
Mailing address:
  • Phone: 213-381-1250
  • Fax: 213-383-4803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number32469
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: