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General NPI Number Information
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NPI Number | 1578734125
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Entity Type | Individual
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Provider Name | MIKE AZARYA SELIKTAR PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/21/2008
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Last Update Date | 11/21/2013
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Provider Practice Location Address
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Address Line | 4929 WILSHIRE BLVD SUITE 510
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City | LOS ANGELES
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State | CA
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Zip | 90010-3808
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Country | US
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Telephone | 562-904-3999
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Fax | 855-688-6746
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Provider Business Mailing Address
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Address Line | 7250 FRANKLIN AVE. # 810
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City | LOS ANGELES
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State | CA
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Zip | 90046
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Country | US
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Telephone | 323-851-7723
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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