Provider Demographics
NPI:1417993429
Name:EGHRARI, HALEH (PHD)
Entity Type:Individual
Prefix:DR
First Name:HALEH
Middle Name:
Last Name:EGHRARI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 WESTWOOD BLVD
Mailing Address - Street 2:#206
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4902
Mailing Address - Country:US
Mailing Address - Phone:310-441-9550
Mailing Address - Fax:310-234-2682
Practice Address - Street 1:10700 SANTA MONICA BLVD STE 300
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6587
Practice Address - Country:US
Practice Address - Phone:310-441-9550
Practice Address - Fax:310-234-2682
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13673103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP13673BMedicare ID - Type UnspecifiedPROVIDER #