Provider Demographics
NPI:1992329627
Name:KOBA PSYCHOLOGICAL SERVICES PC
Entity type:Organization
Organization Name:KOBA PSYCHOLOGICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOBA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:310-498-5527
Mailing Address - Street 1:1613 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-5212
Mailing Address - Country:US
Mailing Address - Phone:310-498-5527
Mailing Address - Fax:
Practice Address - Street 1:3812 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2413
Practice Address - Country:US
Practice Address - Phone:310-388-7770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty