Provider Demographics
NPI:1508658022
Name:CENTURY CITY PSYCHIATRY
Entity type:Organization
Organization Name:CENTURY CITY PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:NISSAN
Authorized Official - Last Name:MAHGEREFTEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-340-0089
Mailing Address - Street 1:10323 SANTA MONICA BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5056
Mailing Address - Country:US
Mailing Address - Phone:310-340-0089
Mailing Address - Fax:310-469-9073
Practice Address - Street 1:10323 SANTA MONICA BLVD STE 108
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5056
Practice Address - Country:US
Practice Address - Phone:310-340-0089
Practice Address - Fax:310-469-9073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty