Healthcare Provider Details

I. General information

NPI: 1922275635
Provider Name (Legal Business Name): DR. PAULENE B POPEK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAULENE B POPEK PH.D.

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10950 SARBONNE LN
LOS ANGELES CA
90077-2234
US

IV. Provider business mailing address

10950 SARBONNE LN
LOS ANGELES CA
90077-2234
US

V. Phone/Fax

Practice location:
  • Phone: 310-472-2061
  • Fax: 310-472-7563
Mailing address:
  • Phone: 310-472-2061
  • Fax: 310-472-7563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberPSY10386
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: