Healthcare Provider Details

I. General information

NPI: 1124183561
Provider Name (Legal Business Name): MIRIAM HAMIDEH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31194 LA BAYA DR STE 201
WESTLAKE VILLAGE CA
91362-6431
US

IV. Provider business mailing address

31194 LA BAYA DR STE 201
WESTLAKE VILLAGE CA
91362-6431
US

V. Phone/Fax

Practice location:
  • Phone: 747-222-7464
  • Fax: 310-919-3755
Mailing address:
  • Phone: 805-797-7875
  • Fax: 310-919-3755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY17320
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY17320
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: