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General NPI Number Information
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NPI Number | 1396221016
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Entity Type | Organization
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Legal Business Name | STRAIGHT UP TREATMENT, INC.
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Dates
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Enumeration Date | 07/16/2018
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Last Update Date | 07/16/2018
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Provider Practice Location Address
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Address Line | 1180 S BEVERLY DR STE 401
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City | LOS ANGELES
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State | CA
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Zip | 90035-1156
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Country | US
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Telephone | 424-235-7095
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Fax |
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Provider Business Mailing Address
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Address Line | 330 N SCREENLAND DR APT 327
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City | BURBANK
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State | CA
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Zip | 91505-3870
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | CHRISTINE IZQUIERDO
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Credential | PSY.D.
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Telephone | 424-235-7095
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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 |
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License Number State |
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