Provider Demographics
NPI:1447231246
Name:REZAIPOUR, BAHMAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:BAHMAN
Middle Name:
Last Name:REZAIPOUR
Suffix:
Gender:M
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:PO BOX 4921
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91308-4921
Mailing Address - Country:US
Mailing Address - Phone:310-421-8211
Mailing Address - Fax:
Practice Address - Street 1:1314 WESTWOOD BLVD
Practice Address - Street 2:UNIT 211
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4902
Practice Address - Country:US
Practice Address - Phone:310-421-8211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17817103TC0700X
CO2418103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY17817Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST