Healthcare Provider Details

I. General information

NPI: 1063725794
Provider Name (Legal Business Name): AMI ISRAEL STUDENT PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39900 DESERT SUN DR
RANCHO MIRAGE CA
92270-3607
US

IV. Provider business mailing address

42440 BOB HOPE DR SUITE 1 #150
RANCHO MIRAGE CA
92270
US

V. Phone/Fax

Practice location:
  • Phone: 213-465-0040
  • Fax:
Mailing address:
  • Phone: 213-465-0040
  • Fax: 949-739-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number27086
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number028135
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number202862
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3673
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: