Deborah Matian Shoham, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

30162 Issued in CA

Practice address

11340 W Olympic Blvd # 515
Los Angeles, CA 90064-1608

Phone

(424) 341-2104

NPI assigned

Jul 8, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1404777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539043200000",
    "number": "1649686858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16990 OAK VIEW DR",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914363242",
            "telephone_number": "818-915-6665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11340 W OLYMPIC BLVD # 515",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900641608",
            "telephone_number": "424-341-2104"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4760 Sepulveda Blvd",
            "address_purpose": "LOCATION",
            "city": "Culver City",
            "state": "CA",
            "postal_code": "902304820",
            "country_code": "US",
            "telephone_number": "310-751-5344",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHOHAM",
        "first_name": "DEBORAH",
        "middle_name": "MATIAN",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-07-08",
        "last_updated": "2018-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "30162",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.