Provider Demographics
NPI:1184133944
Name:MAHTOV, ORAH
Entity type:Individual
Prefix:
First Name:ORAH
Middle Name:
Last Name:MAHTOV
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 1:6051 LINDLEY AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1725
Mailing Address - Country:US
Mailing Address - Phone:818-672-6724
Mailing Address - Fax:
Practice Address - Street 1:14600 SHERMAN WAY STE 250
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2284
Practice Address - Country:US
Practice Address - Phone:818-212-2223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95007450363L00000X
CA95007450363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner