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General NPI Number Information
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NPI Number | 1114355237
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Entity Type | Organization
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Legal Business Name | WESTSIDE NEUROTHERAPEUTICS, LLC.
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Dates
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Enumeration Date | 10/29/2013
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Last Update Date | 10/29/2013
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Provider Practice Location Address
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Address Line | 10850 WILSHIRE BLVD 1260
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City | LOS ANGELES
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State | CA
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Zip | 90024-4305
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Country | US
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Telephone | 310-946-0008
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Fax | 310-209-0444
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Provider Business Mailing Address
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Address Line | 10850 WILSHIRE BLVD 1260
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City | LOS ANGELES
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State | CA
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Zip | 90024-4305
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Country | US
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Telephone | 310-946-0008
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Fax | 310-209-0444
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TANYA VAPNIK
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Credential | PH.D.
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Telephone | 310-946-0008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | PSY17275
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License Number State | CA
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