Provider Demographics
NPI:1104037811
Name:OLMOS, NATASHA THAPAR (PHD)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:THAPAR
Last Name:OLMOS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JOHN WOODEN CTR W
Mailing Address - Street 2:BOX 951556
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-1556
Mailing Address - Country:US
Mailing Address - Phone:310-825-0768
Mailing Address - Fax:310-206-7365
Practice Address - Street 1:JOHN WOODEN CTR W
Practice Address - Street 2:BOX 951556
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1556
Practice Address - Country:US
Practice Address - Phone:310-825-0768
Practice Address - Fax:310-206-7365
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24784103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical