Provider Demographics
NPI:1235163320
Name:ACKERMAN, PAUL H (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:H
Last Name:ACKERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12520 SHADY DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-3814
Mailing Address - Country:US
Mailing Address - Phone:310-826-4881
Mailing Address - Fax:310-476-5819
Practice Address - Street 1:12520 SHADY DR
Practice Address - Street 2:STE 621
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-3814
Practice Address - Country:US
Practice Address - Phone:310-476-5818
Practice Address - Fax:310-476-5819
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG118392084B0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA90165Medicare ID - Type UnspecifiedMEDICARE