Provider Demographics
NPI:1720337140
Name:MALAKUTI, KATRIN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KATRIN
Middle Name:
Last Name:MALAKUTI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9171 WILSHIRE BLVD SUITE 660
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-3414
Mailing Address - Country:US
Mailing Address - Phone:424-645-7793
Mailing Address - Fax:424-645-7793
Practice Address - Street 1:3580 WILSHIRE BLVD STE 2000
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2533
Practice Address - Country:US
Practice Address - Phone:213-381-1250
Practice Address - Fax:213-383-4803
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26550103TC0700X
225C00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program