Healthcare Provider Details

I. General information

NPI: 1376251892
Provider Name (Legal Business Name): NINA SNGH AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4443 AMBROSE AVE
LOS ANGELES CA
90027-2114
US

IV. Provider business mailing address

4117 EDENHURST AVE
LOS ANGELES CA
90039-1305
US

V. Phone/Fax

Practice location:
  • Phone: 310-853-0720
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number130608
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: