Provider Demographics
NPI:1528080645
Name:PFUSION PSYCHOLOGICAL SER INC.
Entity type:Organization
Organization Name:PFUSION PSYCHOLOGICAL SER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:310-552-8050
Mailing Address - Street 1:337 S BEVERLY DR
Mailing Address - Street 2:107
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4315
Mailing Address - Country:US
Mailing Address - Phone:310-552-8050
Mailing Address - Fax:310-552-8052
Practice Address - Street 1:337 S BEVERLY DR
Practice Address - Street 2:107
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4315
Practice Address - Country:US
Practice Address - Phone:310-552-8050
Practice Address - Fax:310-552-8052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
X57155Medicare UPIN
CAW15172Medicare PIN