| Lina Suchov A Professional Psychology Corporation | |
|
16260 Ventura Blvd Suite Lle 30 Encino CA 91436-2203 | |
| (818) 385-0336 | |
| (818) 385-1310 |
| Full Name | Lina Suchov A Professional Psychology Corporation |
|---|---|
| Speciality | Psychologist |
| Location | 16260 Ventura Blvd, Encino, California |
| Authorized Official Name and Position | Lina Suchov (OWNER) |
| Authorized Official Contact | 8183850336 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lina Suchov A Professional Psychology Corporation 16260 Ventura Blvd Suite Lle 30 Encino CA 92590-4927 Ph: (818) 385-0336 | Lina Suchov A Professional Psychology Corporation 16260 Ventura Blvd Suite Lle 30 Encino CA 91436-2203 Ph: (818) 385-0336 |
| NPI Number | 1588085328 |
|---|---|
| Provider Enumeration Date | 12/20/2013 |
| Last Update Date | 12/20/2013 |
| Medicare PECOS PAC ID | 7618104399 |
|---|---|
| Medicare Enrollment ID | O20131231000217 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588085328 | NPI | - | NPPES |
| 14451 | Other | CA | PSY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PSY 14451 (California) | Primary |
| Provider Name | Lina B Suchov |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1740384833 PECOS PAC ID: 2668464314 Enrollment ID: I20040401000828 |
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