Provider Demographics
NPI:1215318423
Name:RAYMOND NOURMAND, PH.D.
Entity type:Organization
Organization Name:RAYMOND NOURMAND, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:SALAR
Authorized Official - Last Name:NOURMAND
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-963-4007
Mailing Address - Street 1:11911 SAN VICENTE BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-5086
Mailing Address - Country:US
Mailing Address - Phone:310-963-4007
Mailing Address - Fax:
Practice Address - Street 1:11911 SAN VICENTE BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-5086
Practice Address - Country:US
Practice Address - Phone:310-963-4007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-12
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 26470103TC0700X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty