MEDICARE: DIDI HIRSCH PSYCHIATRIC SERVICE

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1841807666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIDI HIRSCH PSYCHIATRIC SERVICE

Provider Business Mailing Address
First Line	:	4760 SEPULVEDA BLVD
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-4820
Country	:	US
Telephone Number	:	310-390-6612
Fax Number	:	310-751-5481

Provider Business Practice Location Address
First Line	:	10101 S BROADWAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90003-4534
Country	:	US
Telephone Number	:	323-920-6125
Fax Number	:

Authorized Official
Title or Position	:	CONTRACTS & GRANTS MANAGER
Name	:	DULCE M RUIZ
Credential	:
Telephone Number	:	310-751-5442

Provider Enumeration Date	:	09/25/2020
Last Update Date	:	09/25/2020

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