Provider Demographics
NPI:1407406895
Name:NOSRATI, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:NOSRATI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2337 ROSCOMARE RD # 2-321
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1854
Mailing Address - Country:US
Mailing Address - Phone:310-564-4645
Mailing Address - Fax:310-564-4647
Practice Address - Street 1:2001 S BARRINGTON AVE STE 203
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5385
Practice Address - Country:US
Practice Address - Phone:310-564-4645
Practice Address - Fax:310-564-4647
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-17
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS292931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS29293OtherNOT YET CONTRACTED WITH INSURANCE PROVIDER