=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619270709
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ATRIUM SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2010
-----------------------------------------------------
Last Update Date | 10/24/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11500 W OLYMPIC BLVD STE 580
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90064-1524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-464-1165
-----------------------------------------------------
Fax | 310-966-9215
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11500 W OLYMPIC BLVD STE 580
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90064-1524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-464-1165
-----------------------------------------------------
Fax | 310-966-9215
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DAVID J GYEPES
-----------------------------------------------------
Credential | J.D., PH. D., QME
-----------------------------------------------------
Telephone | 310-464-1165
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | PSY18840
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------