Healthcare Provider Details

I. General information

NPI: 1649618125
Provider Name (Legal Business Name): HODA ABOU-ZIAB PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 07/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST
TORRANCE CA
90502-2004
US

IV. Provider business mailing address

1000 W CARSON ST # 36
TORRANCE CA
90502-2059
US

V. Phone/Fax

Practice location:
  • Phone: 310-222-3198
  • Fax:
Mailing address:
  • Phone: 949-338-5844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY29984
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: