Healthcare Provider Details

I. General information

NPI: 1063790533
Provider Name (Legal Business Name): FARAH EL KHATIB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 VINE ST SUITE 101
LOS ANGELES CA
90038-1612
US

IV. Provider business mailing address

1224 VINE ST
LOS ANGELES CA
90038-1612
US

V. Phone/Fax

Practice location:
  • Phone: 323-769-6100
  • Fax:
Mailing address:
  • Phone: 132-376-9610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number69912
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: