Basic Information
| Provider Information | |||||||||
| NPI: | 1356895734 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEBOVIC | ||||||||
| FirstName: | MISHGA | ||||||||
| MiddleName: | VERA SOHRABI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3880 S BASCOM AVE STE 115 | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951242600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4083511044 | ||||||||
| FaxNumber: | 4087967477 | ||||||||
| Practice Location | |||||||||
| Address1: | 3880 S BASCOM AVE STE 115 | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951242600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4083511044 | ||||||||
| FaxNumber: | 4087967477 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2016 | ||||||||
| LastUpdateDate: | 05/03/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | D3530786 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.