Organization
PAUL H ACKERMAN M D INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL H ACKERMAN M.D. (PRESIDENT)
(310) 826-4882
Entity
Organization
Contact information
Practice address
11980 SAN VICENTE BLVD, SUITE 621, LOS ANGELES, CA 90049-5012
(310) 826-4882
(310) 476-5819
Mailing address
11980 SAN VICENTE BLVD, SUITE 621, LOS ANGELES, CA 90049-5012
(310) 826-4882
(310) 476-5819
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
G11839
CA
261QM0850X
Adult Mental Health Clinic/Center
G11839
CA
Other
Enumeration date
07/26/2010
Last updated
08/10/2010
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