Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PSY 15091 | CA |
N | 103TC0700X | Clinical Psychologist | PSY 15091 | CA |
Y | 102L00000X | Psychologist | PSY 15091 | CA |
Y | 103T00000X | Psychologist | PSY 15091 | CA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSY 15091 | CA |
N | 103TA0700X | Adult Development & Aging Psychologist | PSY 15091 | CA |
N | 103G00000X | Clinical Psychologist | PSY 15091 | CA |
N | 103TC0700X | Clinical Psychologist | PSY 15091 | CA |
N | 103TC1900X | Counseling Psychologist | PSY 15091 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY 15091 | CA |
N | 103TE1100X | Exercise & Sports Psychologist | PSY 15091 | CA |
N | 103TF0000X | Family Psychologist | PSY 15091 | CA |
N | 103TF0200X | Forensic Psychologist | PSY 15091 | CA |
N | 103TP2701X | Group Psychotherapist | PSY 15091 | CA |
NPI | 1265596134 |
---|---|
Provider Name | Dr. Reuben Vaisman-Tzachor |
First Address | Los Angeles, CA 90025-4090 |
Second Address | Santa Monica, CA 90404-4278 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 02/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00CA98888 | BLUE SHIELD PROVIDER NUMB (01) | CA |
0PHD0000 | BLUE SHIELD OF CALIFORNIA (01) | CA |
C CP15091 | UN ITED AMERICAN INSURANC (01) | CA |