Provider Demographics
NPI:1538672027
Name:NEMATOLLAHI, RAMIN
Entity Type:Individual
Prefix:
First Name:RAMIN
Middle Name:
Last Name:NEMATOLLAHI
Suffix:
Gender:M
Credentials:
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 2492
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90231-2492
Mailing Address - Country:US
Mailing Address - Phone:562-726-4618
Mailing Address - Fax:
Practice Address - Street 1:7000 ROMAINE ST
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90038-2304
Practice Address - Country:US
Practice Address - Phone:562-726-4618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-07
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102792106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist