Individual provider Active NPI

Chrystal Rahmani, PH.D.

  • Clinical Psychologist
  • Los Angeles, CA
National Provider Identifier
1104226885
Registry record updated Dec 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY 28890 Issued in CA
Practice address
12301 Wilshire Blvd Ste 416
Los Angeles, CA 90025-1051
Phone
(424) 248-8644
NPI assigned
Aug 29, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 27, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY 28890 CA Primary

Addresses

Primary practice location

12301 Wilshire Blvd Ste 416
Los Angeles, CA 90025-1051

Mailing address

23838 Pacific Coast Hwy Unit 2291
Malibu, CA 90265-1497

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170217000531 CA Practitioner - Clinical Psychologist 1456634427 Practice locations: Santa Monica, CA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3301 Ocean Park Blvd
Suite 210
Santa Monica, CA 90405-3230
Phone (424) 248-8644

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY 28890CAMDClinical Psychologist
28890CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Santa Monica Therapy, a Psychology Corporation Clinical PastSince Sep 21, 2020 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1409270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482796800000",
    "number": "1104226885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23838 PACIFIC COAST HWY UNIT 2291",
            "city": "MALIBU",
            "state": "CA",
            "postal_code": "902651497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12301 WILSHIRE BLVD STE 416",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900251051",
            "telephone_number": "424-248-8644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAHMANI",
        "first_name": "CHRYSTAL",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-08-29",
        "last_updated": "2016-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY 28890",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.