=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588434344
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CALIFORNIA PSYCHOLOGY CLINICS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2024
-----------------------------------------------------
Last Update Date | 01/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3301 OCEAN PARK BLVD STE 107
-----------------------------------------------------
City | SANTA MONICA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90405-3223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-857-4946
-----------------------------------------------------
Fax | 310-601-5193
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10636 WILSHIRE BLVD APT 511
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90024-7330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-857-4946
-----------------------------------------------------
Fax | 310-601-5193
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SOHEILA HOSSEINI
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 310-857-4946
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------