MEDICARE: PRABHJOT SIDHU

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	106H00000X	Marriage & Family Therapist	LMFT146511	CA

General Provider Information

NPI Number	:	1437678497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRABHJOT SIDHU

Provider Business Mailing Address
First Line	:	PO BOX 222
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91603-0222
Country	:	US
Telephone Number	:	213-326-3925
Fax Number	:

Provider Business Practice Location Address
First Line	:	8750 S VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90044-4830
Country	:	US
Telephone Number	:	323-751-3026
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2017
Last Update Date	:	04/23/2024

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