MEDICARE: MYRA POMERANTZ PH.D.

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	103TC0700X	Clinical Psychologist	PSY15885	CA

General Provider Information

NPI Number	:	1932318003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYRA POMERANTZ PH.D.

Provider Business Mailing Address
First Line	:	10444 SANTA MONICA BLVD
Second Line	:	SUITE 204
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-6959
Country	:	US
Telephone Number	:	310-277-1020
Fax Number	:	310-277-8903

Provider Business Practice Location Address
First Line	:	10444 SANTA MONICA BLVD
Second Line	:	SUITE 204
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-6959
Country	:	US
Telephone Number	:	310-277-1020
Fax Number	:	310-277-8903

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	08/05/2013

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