Provider Demographics
NPI:1013565050
Name:BAKHAJ, DELILAH S
Entity Type:Individual
Prefix:
First Name:DELILAH
Middle Name:S
Last Name:BAKHAJ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18034 VENTURA BLVD # 267
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3516
Mailing Address - Country:US
Mailing Address - Phone:818-667-1053
Mailing Address - Fax:
Practice Address - Street 1:21243 VENTURA BLVD STE 126
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2164
Practice Address - Country:US
Practice Address - Phone:818-667-1053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-03
Last Update Date:2022-09-08
Deactivation Date:2020-10-08
Deactivation Code:
Reactivation Date:2020-12-02
Provider Licenses
StateLicense IDTaxonomies
CA134205106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-2633765OtherMEDI-CAL