Healthcare Provider Details

I. General information

NPI: 1710174149
Provider Name (Legal Business Name): DIDI HIRSCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 10/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12420 VENICE BLVD 200
LOS ANGELES CA
90066-3840
US

IV. Provider business mailing address

4760 SEPULVEDA BLVD
CULVER CITY CA
90230-4820
US

V. Phone/Fax

Practice location:
  • Phone: 310-751-1200
  • Fax:
Mailing address:
  • Phone: 310-157-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number54436
License Number StateCA

VIII. Authorized Official

Name: JENNY YVETTE RAMIREZ
Title or Position: BILINGUAL THERAPIST I
Credential: MFTI
Phone: 310-751-5437