Basic Information
Provider Information | |||||||||
NPI: | 1194035238 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | DIDI HIRSCH PSYCHIATRIC SERVICE | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | DIDI HIRSCH CRISIS PREVENTION HOTLINE | ||||||||
OtherOrganizationType: | 5 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4760 SEPULVEDA BLVD | ||||||||
Address2: |   | ||||||||
City: | CULVER CITY | ||||||||
State: | CA | ||||||||
PostalCode: | 902304820 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3103906612 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 10277 W OLYMPIC BLVD | ||||||||
Address2: |   | ||||||||
City: | LOS ANGELES | ||||||||
State: | CA | ||||||||
PostalCode: | 900677005 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3108952300 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/07/2010 | ||||||||
LastUpdateDate: | 10/06/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | RUIZ | ||||||||
AuthorizedOfficialFirstName: | DULCE | ||||||||
AuthorizedOfficialMiddleName: | M | ||||||||
AuthorizedOfficialTitleorPosition: | CONTRACTS & GRANTS MANAGER | ||||||||
AuthorizedOfficialTelephone: | 3107515442 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/06/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 252Y00000X |   |   | Y |   | Agencies | Early Intervention Provider Agency |   |
No ID Information.