Provider Demographics
NPI:1558486118
Name:MATLOOB, AFSANEH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AFSANEH
Middle Name:
Last Name:MATLOOB
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1293 S BEVERLY GLEN BLVD APT 308
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-5252
Mailing Address - Country:US
Mailing Address - Phone:310-701-0157
Mailing Address - Fax:
Practice Address - Street 1:1293 S BEVERLY GLEN BLVD APT 308
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-5252
Practice Address - Country:US
Practice Address - Phone:310-701-0157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21145103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical