Provider Demographics
NPI:1285056168
Name:HYMAN, MANUELA (PPS)
Entity type:Individual
Prefix:
First Name:MANUELA
Middle Name:
Last Name:HYMAN
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:MANUELA
Other - Middle Name:
Other - Last Name:MOSKOVITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1118 GLENVILLE DR APT 102
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1221
Mailing Address - Country:US
Mailing Address - Phone:310-666-6524
Mailing Address - Fax:
Practice Address - Street 1:1118 GLENVILLE DR APT 102
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1221
Practice Address - Country:US
Practice Address - Phone:310-666-6524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA130101022103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool