Provider Demographics
NPI:1124151212
Name:PIRHEKAYATY, TAHEREH (CLINICAL PSYCHOLOGIS)
Entity type:Individual
Prefix:DR
First Name:TAHEREH
Middle Name:
Last Name:PIRHEKAYATY
Suffix:
Gender:F
Credentials:CLINICAL PSYCHOLOGIS
Other - Prefix:DR
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:PIR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CLINICAL PSYCHOLOGIS
Mailing Address - Street 1:3580 WILSHIRE BLVD STE 2000
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2521
Mailing Address - Country:US
Mailing Address - Phone:213-381-1250
Mailing Address - Fax:213-383-4803
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:90010-2521
Practice Address - Country:US
Practice Address - Phone:213-381-1250
Practice Address - Fax:213-383-4803
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY115250103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9301126Medicaid
CAF699219OtherMEDICAL PROVIDER
CACP11525Medicare ID - Type UnspecifiedMEDICARE PROVIDER