Basic Information
| Provider Information | |||||||||
| NPI: | 1780004697 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAHSOUN | ||||||||
| FirstName: | PASHA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4221 WILSHIRE BLVD | ||||||||
| Address2: | 300 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900103512 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4221 WILSHIRE BLVD | ||||||||
| Address2: | 300 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900103512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238661880 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2014 | ||||||||
| LastUpdateDate: | 04/17/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.