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General NPI Number Information
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NPI Number | 1376959429
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Entity Type | Organization
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Legal Business Name | LOS ANGELES BDD & BODY IMAGE CLINIC
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Dates
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Enumeration Date | 07/09/2014
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Last Update Date | 07/09/2014
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Provider Practice Location Address
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Address Line | 10780 SANTA MONICA BLVD STE 120
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City | LOS ANGELES
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State | CA
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Zip | 90025-7613
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Country | US
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Telephone | 310-741-2000
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Fax | 888-239-6367
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Provider Business Mailing Address
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Address Line | 10780 SANTA MONICA BLVD STE 120
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City | LOS ANGELES
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State | CA
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Zip | 90025-7613
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Country | US
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Telephone | 310-741-2000
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Fax | 888-239-6367
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. ARIE WINOGRAD
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Credential | LMFT
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Telephone | 310-741-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC39567
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License Number State | CA
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