Basic Information
| Provider Information | |||||||||
| NPI: | 1043497415 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOIKANYO | ||||||||
| FirstName: | MANTSHA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PSYD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BOIKANYO | ||||||||
| OtherFirstName: | MANTSHA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | MFTI | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3200 MOTOR AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900343710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108361223 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2001 S BARRINGTON AVE STE 314 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900255379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4247817650 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2008 | ||||||||
| LastUpdateDate: | 09/12/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TA0400X | N | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | 103TA0700X | N | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging | 103TC0700X | PSY29845 | CA | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC2200X | N | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 103TE1100X | N | Behavioral Health & Social Service Providers | Psychologist | Exercise & Sports | 103TF0000X | N | Behavioral Health & Social Service Providers | Psychologist | Family | 103TH0004X | N | Behavioral Health & Social Service Providers | Psychologist | Health | 103TP2701X | N | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | 103TR0400X | N | Behavioral Health & Social Service Providers | Psychologist | Rehabilitation | 103TS0200X | N | Behavioral Health & Social Service Providers | Psychologist | School | 106H00000X | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 225400000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | 103T00000X | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.