Healthcare Provider Details

I. General information

NPI: 1689389603
Provider Name (Legal Business Name): TOTAL LIFE CA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 01/16/2023
Certification Date: 01/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6080 CENTER DR FL 6
LOS ANGELES CA
90045-9205
US

IV. Provider business mailing address

6080 CENTER DR FL 6
LOS ANGELES CA
90045-9205
US

V. Phone/Fax

Practice location:
  • Phone: 800-567-5433
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: NEELKAMAL BRAR
Title or Position: ADMIN
Credential:
Phone: 347-527-6695