=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780715771
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIDI HIRSCH PSYCHIATRIC SERVICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2007
-----------------------------------------------------
Last Update Date | 02/15/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12420 VENICE BLVD SUITE 200
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90066-3840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-751-1200
-----------------------------------------------------
Fax | 310-398-0312
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4760 SEPULVEDA BLVD
-----------------------------------------------------
City | CULVER CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90230-4820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-390-6612
-----------------------------------------------------
Fax | 310-398-5690
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT AND CEO
-----------------------------------------------------
Name | DR. KITA CURRY
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 310-751-5423
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------