Provider Demographics
NPI:1376803742
Name:PEDIATRIC MINDS DEVELOPMENTAL SERVICES, INC.
Entity Type:Organization
Organization Name:PEDIATRIC MINDS DEVELOPMENTAL SERVICES, INC.
Other - Org Name:PEDIATRIC MINDS DEVELOPMENTAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PANTEA
Authorized Official - Middle Name:SHARIFI
Authorized Official - Last Name:HANNAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-540-1630
Mailing Address - Street 1:3524 TORRANCE BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4821
Mailing Address - Country:US
Mailing Address - Phone:310-540-1630
Mailing Address - Fax:310-540-1610
Practice Address - Street 1:3524 TORRANCE BLVD STE 104
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4821
Practice Address - Country:US
Practice Address - Phone:310-540-1630
Practice Address - Fax:310-540-1610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-20
Last Update Date:2012-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty