Basic Information
| Provider Information | |||||||||
| NPI: | 1720337140 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MALAKUTI | ||||||||
| FirstName: | KATRIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9171 WILSHIRE BLVD SUITE 660 | ||||||||
| Address2: | |||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902103414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4246457793 | ||||||||
| FaxNumber: | 4246457793 | ||||||||
| Practice Location | |||||||||
| Address1: | 3580 WILSHIRE BLVD STE 2000 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900102533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2133811250 | ||||||||
| FaxNumber: | 2133834803 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2012 | ||||||||
| LastUpdateDate: | 02/01/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY26550 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical | 225C00000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.