MEDICARE: HANA IBRAHIMOVIC MCDERMOTT

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
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1881825669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANA IBRAHIMOVIC MCDERMOTT

Provider Business Mailing Address
First Line	:	2000 VOORHEES AVE UNIT 7
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-2341
Country	:	US
Telephone Number	:	310-429-4309
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 VOORHEES AVE UNIT 7
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-2341
Country	:	US
Telephone Number	:	310-429-4309
Fax Number	:

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

Provider Enumeration Date	:	07/28/2009
Last Update Date	:	09/26/2016

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