Organization
KENNETH SUBOTNIK, PH.D., INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH LEE SUBOTNIK PH.D. (DIRECTOR)
(310) 824-4600
Entity
Organization
Contact information
Practice address
10850 WILSHIRE BLVD STE 240, LOS ANGELES, CA 90024-4308
(310) 824-4600
Mailing address
10850 WILSHIRE BLVD STE 240, LOS ANGELES, CA 90024-4308
(310) 824-4600
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
PSY12770
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PSY12770
CALIFORNIA PSYCHOLOGIST LICENSE
CA
05
—
PSY127700
—
CA
Enumeration date
06/02/2008
Last updated
06/02/2008
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