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NPI Code Detail

MEDICARE: L.A. PSYCH

MEDICARE: L.A. PSYCH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologistPSY 21883CA

General Provider Information

NPI Number : 1255603965
Entity Type Code : Organization
Provider Name (Legal Business Name) : L.A. PSYCH
Provider Business Mailing Address
First Line : 11526 BAIRD AVE
Second Line :
City : PORTER RANCH
State : CA
Zip : 91326-1908
Country : US
Telephone Number : 818-523-9394
Fax Number : 818-286-9570
Provider Business Practice Location Address
First Line : 15233 VENTURA BLVD STE 1208
Second Line :
City : SHERMAN OAKS
State : CA
Zip : 91403-2271
Country : US
Telephone Number : 818-523-9394
Fax Number : 818-286-9570
Authorized Official
Title or Position : CLINICAL PSYCHOLOGIST
Name : DR. SHEYDA MIA MELKONIAN
Credential : PSY.D.
Telephone Number : 818-523-9394
Provider Enumeration Date : 01/27/2012
Last Update Date : 01/05/2021

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