Provider Demographics
NPI:1619095973
Name:HRYMOC, ELHAM MIZANI (MD)
Entity Type:Individual
Prefix:
First Name:ELHAM
Middle Name:MIZANI
Last Name:HRYMOC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8631 W 3RD ST STE 920
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5919
Mailing Address - Country:US
Mailing Address - Phone:310-601-9999
Mailing Address - Fax:
Practice Address - Street 1:8631 W 3RD ST STE 920
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5919
Practice Address - Country:US
Practice Address - Phone:310-601-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA979302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry