Provider Demographics
NPI:1366738676
Name:MANAGEDMED, INC.
Entity type:Organization
Organization Name:MANAGEDMED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:HIRSCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:323-934-3861
Mailing Address - Street 1:5455 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 1903
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-4201
Mailing Address - Country:US
Mailing Address - Phone:323-934-3861
Mailing Address - Fax:
Practice Address - Street 1:5455 WILSHIRE BLVD
Practice Address - Street 2:SUITE 1903
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4201
Practice Address - Country:US
Practice Address - Phone:323-934-3861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 19483103TC0700X
CAA65071207R00000X
CAA18616207X00000X
CAPSY 7084103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty