Provider Demographics
NPI:1831358118
Name:NATHA, URVI MAHENDRA (PSYD)
Entity type:Individual
Prefix:
First Name:URVI
Middle Name:MAHENDRA
Last Name:NATHA
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:PO BOX 3453
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-1453
Mailing Address - Country:US
Mailing Address - Phone:310-944-1058
Mailing Address - Fax:
Practice Address - Street 1:212 YACHT CLUB WAY STE A6
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-6907
Practice Address - Country:US
Practice Address - Phone:310-956-1406
Practice Address - Fax:424-262-1008
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2019-07-25
Deactivation Date:2012-06-15
Deactivation Code:
Reactivation Date:2016-08-12
Provider Licenses
StateLicense IDTaxonomies
CA27868103TA0400X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)