Provider Demographics
NPI:1437303708
Name:COMPREHENSIVE NEUROBEHAVIORAL SPECIALISTS
Entity Type:Organization
Organization Name:COMPREHENSIVE NEUROBEHAVIORAL SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAMOUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-440-9800
Mailing Address - Street 1:149 S BARRINGTON AVE
Mailing Address - Street 2:SUITE 444
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-3310
Mailing Address - Country:US
Mailing Address - Phone:310-440-9800
Mailing Address - Fax:310-440-9810
Practice Address - Street 1:11911 SAN VICENTE BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-5086
Practice Address - Country:US
Practice Address - Phone:310-440-9800
Practice Address - Fax:310-440-9810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-12
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA996372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty