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NPI Code Detail

MEDICARE: SACHA BOLLAS PSYD, INC.

MEDICARE: SACHA BOLLAS PSYD, 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
1103TB0200XCognitive & Behavioral Psychologist
2103TC2200XClinical Child & Adolescent Psychologist
3103TP0814XPsychoanalysis Psychologist
4103TC0700XClinical Psychologist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1NONEOTHERNONE

General Provider Information

NPI Number : 1801424742
Entity Type Code : Organization
Provider Name (Legal Business Name) : SACHA BOLLAS PSYD, INC.
Provider Business Mailing Address
First Line : 3786 BEETHOVEN ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90066-3536
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1990 S BUNDY DR STE 320
Second Line :
City : LOS ANGELES
State : CA
Zip : 90025-5249
Country : US
Telephone Number : 310-741-7408
Fax Number :
Authorized Official
Title or Position : CLINICAL PSYCHOLOGIST
Name : SACHA BOLLAS
Credential : PSYD
Telephone Number : 310-741-7408
Provider Enumeration Date : 03/27/2020
Last Update Date : 03/27/2020

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