Healthcare Provider Details

I. General information

NPI: 1265191928
Provider Name (Legal Business Name): LEILA MALEKPOUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17837 SHERMAN WAY APT 109
RESEDA CA
91335-3379
US

IV. Provider business mailing address

18646 OXNARD ST
TARZANA CA
91356-1411
US

V. Phone/Fax

Practice location:
  • Phone: 949-282-7464
  • Fax:
Mailing address:
  • Phone: 949-282-7464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number108873
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: