Healthcare Provider Details

I. General information

NPI: 1033584818
Provider Name (Legal Business Name): PAULA THOMSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2015
Last Update Date: 12/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 BAKMAN AVE
STUDIO CITY CA
91602-3319
US

IV. Provider business mailing address

4160 BAKMAN AVE
STUDIO CITY CA
91602-3319
US

V. Phone/Fax

Practice location:
  • Phone: 818-372-6240
  • Fax:
Mailing address:
  • Phone: 818-372-6240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY16652
License Number StateCA

VIII. Authorized Official

Name: DR. PAULA THOMSON
Title or Position: PSYCHOLOGIST
Credential: PSYD
Phone: 818-372-6240