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General NPI Number Information
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NPI Number | 1588073449
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Entity Type | Organization
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Legal Business Name | LIFESPAN HEALTH NETWORK
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Dates
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Enumeration Date | 08/05/2014
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Last Update Date | 08/05/2014
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Provider Practice Location Address
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Address Line | 1171 S ROBERTSON BLVD SUITE 415
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City | LOS ANGELES
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State | CA
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Zip | 90035-1403
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Country | US
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Telephone | 310-739-1167
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Fax |
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Provider Business Mailing Address
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Address Line | 1171 S ROBERTSON BLVD SUITE 415
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City | LOS ANGELES
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State | CA
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Zip | 90035-1403
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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 | PRESIDENT
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Name | MARION AROM
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Credential | PH.D.
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Telephone | 310-739-1167
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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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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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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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