Provider Demographics
NPI:1366149924
Name:BAMDAD, LEILA
Entity type:Individual
Prefix:
First Name:LEILA
Middle Name:
Last Name:BAMDAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 S BARRINGTON AVE STE 314
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5379
Mailing Address - Country:US
Mailing Address - Phone:323-794-5812
Mailing Address - Fax:
Practice Address - Street 1:2001 S BARRINGTON AVE STE 314
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5379
Practice Address - Country:US
Practice Address - Phone:310-999-9683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94025113103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist