Provider Demographics
NPI:1114355237
Name:WESTSIDE NEUROTHERAPEUTICS, LLC.
Entity Type:Organization
Organization Name:WESTSIDE NEUROTHERAPEUTICS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAPNIK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-946-0008
Mailing Address - Street 1:10850 WILSHIRE BLVD
Mailing Address - Street 2:1260
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4305
Mailing Address - Country:US
Mailing Address - Phone:310-946-0008
Mailing Address - Fax:310-209-0444
Practice Address - Street 1:10850 WILSHIRE BLVD
Practice Address - Street 2:1260
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4305
Practice Address - Country:US
Practice Address - Phone:310-946-0008
Practice Address - Fax:310-209-0444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17275103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty