Provider Demographics
NPI:1265138630
Name:A GHEYTANCHI PHD, A PSYCHOLOGICAL CORPORATION
Entity type:Organization
Organization Name:A GHEYTANCHI PHD, A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANAHITA
Authorized Official - Middle Name:
Authorized Official - Last Name:GHEYTANCHI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-709-3073
Mailing Address - Street 1:10384 HOLMAN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-5351
Mailing Address - Country:US
Mailing Address - Phone:323-270-1083
Mailing Address - Fax:
Practice Address - Street 1:3301 OCEAN PARK BLVD STE 110
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-3223
Practice Address - Country:US
Practice Address - Phone:310-709-3073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1538477800OtherNPI