Healthcare Provider Details

I. General information

NPI: 1831358118
Provider Name (Legal Business Name): URVI MAHENDRA NATHA PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date: 06/15/2012
Reactivation Date: 08/12/2016

III. Provider practice location address

212 YACHT CLUB WAY STE A6
REDONDO BEACH CA
90277-6907
US

IV. Provider business mailing address

PO BOX 3453
REDONDO BEACH CA
90277-1453
US

V. Phone/Fax

Practice location:
  • Phone: 310-956-1406
  • Fax: 424-262-1008
Mailing address:
  • Phone: 310-944-1058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number27868
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number27868
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: