Healthcare Provider Details

I. General information

NPI: 1912203969
Provider Name (Legal Business Name): LEILA MESGHALI LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

22669 PACIFIC COAST HWY
MALIBU CA
90265-5036
US

IV. Provider business mailing address

22669 PACIFIC COAST HWY
MALIBU CA
90265-5036
US

V. Phone/Fax

Practice location:
  • Phone: 310-600-1530
  • Fax: 310-919-3667
Mailing address:
  • Phone: 310-600-1530
  • Fax: 310-919-3667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number36191
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: