MEDICARE: THIS LIFE PHD PSYCHOLOGY INC

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
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1386406346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THIS LIFE PHD PSYCHOLOGY INC

Provider Business Mailing Address
First Line	:	2444 WILSHIRE BLVD STE 202
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-5810
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2444 WILSHIRE BLVD STE 202
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-5810
Country	:	US
Telephone Number	:	626-657-7155
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. SANAM RAMZI SHAMTOBI
Credential	:	PHD
Telephone Number	:	310-666-6027

Provider Enumeration Date	:	01/25/2024
Last Update Date	:	01/25/2024

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