| Koba Psychological Services Pc | |
|
3812 Sepulveda Blvd Torrance CA 90505-2413 | |
| (310) 388-7770 | |
| Not Available |
| Full Name | Koba Psychological Services Pc |
|---|---|
| Speciality | Psychologist |
| Location | 3812 Sepulveda Blvd, Torrance, California |
| Authorized Official Name and Position | Yulia Koba (PRESIDENT) |
| Authorized Official Contact | 3104985527 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Koba Psychological Services Pc 1613 Chestnut Ave Manhattan Beach CA 90266-5212 Ph: (310) 498-5527 | Koba Psychological Services Pc 3812 Sepulveda Blvd Torrance CA 90505-2413 Ph: (310) 388-7770 |
| NPI Number | 1992329627 |
|---|---|
| Provider Enumeration Date | 05/28/2020 |
| Last Update Date | 05/28/2020 |
| Certification Date | 05/28/2020 |
| Medicare PECOS PAC ID | 4385064633 |
|---|---|
| Medicare Enrollment ID | O20201026002575 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992329627 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Nicole Mitsuuchi |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740657733 PECOS PAC ID: 9032459102 Enrollment ID: I20190327002804 |
| Provider Name | Yulia Koba Antoniadou |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1053746297 PECOS PAC ID: 5294155545 Enrollment ID: I20201026002661 |
| Provider Name | Heidy Odili Salguero-ruano |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790137362 PECOS PAC ID: 2567878358 Enrollment ID: I20210302002055 |
| Provider Name | Kristi Ann Tomlinson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679146146 PECOS PAC ID: 4789068370 Enrollment ID: I20220831001255 |
| Provider Name | Miriam Lytton Zucker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376061135 PECOS PAC ID: 3971971193 Enrollment ID: I20221119000372 |
| Provider Name | Jeremiah Hein |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508234907 PECOS PAC ID: 5395114342 Enrollment ID: I20221213003136 |
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