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General NPI Number Information
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NPI Number | 1447231246
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Entity Type | Individual
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Provider Name | BAHMAN REZAIPOUR PHD
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Gender | Male
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Dates
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Enumeration Date | 11/09/2005
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Last Update Date | 03/24/2014
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Provider Practice Location Address
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Address Line | 1314 WESTWOOD BLVD UNIT 211
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City | LOS ANGELES
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State | CA
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Zip | 90024-4902
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Country | US
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Telephone | 310-421-8211
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4921
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City | WEST HILLS
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State | CA
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Zip | 91308-4921
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Country | US
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Telephone | 310-421-8211
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 17817
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2418
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License Number State | CO
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