| Chisato Komatsu Psychology Inc. | |
|
6210 Bristol Pkwy Apt 206 Culver City CA 90230-6925 | |
| (213) 407-9048 | |
| Not Available |
| Full Name | Chisato Komatsu Psychology Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 6210 Bristol Pkwy Apt 206, Culver City, California |
| Authorized Official Name and Position | Chisato Komatsu (OWNER) |
| Authorized Official Contact | 2134079048 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chisato Komatsu Psychology Inc. 6210 Bristol Pkwy Apt 206 Culver City CA 90230-6925 Ph: (213) 407-9048 | Chisato Komatsu Psychology Inc. 6210 Bristol Pkwy Apt 206 Culver City CA 90230-6925 Ph: (213) 407-9048 |
| NPI Number | 1205545910 |
|---|---|
| Provider Enumeration Date | 11/21/2022 |
| Last Update Date | 11/21/2022 |
| Certification Date | 11/21/2022 |
| Medicare PECOS PAC ID | 5395103642 |
|---|---|
| Medicare Enrollment ID | O20230620001548 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205545910 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
| Provider Name | Chisato Komatsu |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1073885034 PECOS PAC ID: 0547628893 Enrollment ID: I20230731001050 |
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