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General NPI Number Information
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NPI Number | 1366738676
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Entity Type | Organization
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Legal Business Name | MANAGEDMED, INC.
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Dates
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Enumeration Date | 06/24/2011
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Last Update Date | 06/24/2011
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Provider Practice Location Address
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Address Line | 5455 WILSHIRE BLVD SUITE 1903
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City | LOS ANGELES
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State | CA
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Zip | 90036-4201
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Country | US
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Telephone | 323-934-3861
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Fax |
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Provider Business Mailing Address
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Address Line | 5455 WILSHIRE BLVD SUITE 1903
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City | LOS ANGELES
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State | CA
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Zip | 90036-4201
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Country | US
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Telephone | 323-934-3861
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. SETH L. HIRSCH
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Credential | PH.D.
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Telephone | 323-934-3861
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 19483
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A65071
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | A18616
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 7084
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License Number State | CA
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