Provider Demographics
NPI:1346933967
Name:MAHALLATI, AMIRATA
Entity Type:Individual
Prefix:MR
First Name:AMIRATA
Middle Name:
Last Name:MAHALLATI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12021 ELNORA PL
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-2330
Mailing Address - Country:US
Mailing Address - Phone:310-403-2749
Mailing Address - Fax:
Practice Address - Street 1:24303 WALNUT ST STE C1
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-2900
Practice Address - Country:US
Practice Address - Phone:661-410-6313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist