Healthcare Provider Details

I. General information

NPI: 1104037811
Provider Name (Legal Business Name): NATASHA THAPAR OLMOS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 CENTER DR FL 5
LOS ANGELES CA
90045-9206
US

IV. Provider business mailing address

6100 CENTER DR FL 5
LOS ANGELES CA
90045-9206
US

V. Phone/Fax

Practice location:
  • Phone: 310-568-5654
  • Fax:
Mailing address:
  • Phone: 310-568-5654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number24784
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number24784
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: