Provider Demographics
NPI:1376566190
Name:ALIPOUR, ZARI (PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:ZARI
Middle Name:
Last Name:ALIPOUR
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13428 MAXELLA AVE # 738
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5620
Mailing Address - Country:US
Mailing Address - Phone:310-849-4680
Mailing Address - Fax:
Practice Address - Street 1:12304 SANTA MONICA BLVD STE 215
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2587
Practice Address - Country:US
Practice Address - Phone:310-849-4680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17628103T00000X
CAPSY17628103TC0700X
CAPSY 17628103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1376566190Medicare ID - Type Unspecified
CACP17628Medicare ID - Type Unspecified