Basic Information
| Provider Information | |||||||||
| NPI: | 1043359631 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PORTALS MENTAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 WILSHIRE BLVD | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900574303 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2500 WILSHIRE BLVD | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900574303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2136390299 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GOLDMAN | ||||||||
| AuthorizedOfficialFirstName: | SIMCHA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2136392510 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PH.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | MFC42321 | CA | Y | Agencies | Case Management |
No ID Information.