Healthcare Provider Details

I. General information

NPI: 1720337140
Provider Name (Legal Business Name): KATRIN MALAKUTI PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2012
Last Update Date: 02/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 WILSHIRE BLVD STE 2000
LOS ANGELES CA
90010-2533
US

IV. Provider business mailing address

9171 WILSHIRE BLVD SUITE 660
BEVERLY HILLS CA
90210-3414
US

V. Phone/Fax

Practice location:
  • Phone: 213-381-1250
  • Fax: 213-383-4803
Mailing address:
  • Phone: 424-645-7793
  • Fax: 424-645-7793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY26550
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: