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NPI Code Detail

MEDICARE: ALICIA ZIDE LCSW

MEDICARE: ALICIA ZIDE LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker76965CA

General Provider Information

NPI Number : 1073862926
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALICIA ZIDE LCSW
Provider Business Mailing Address
First Line : PO BOX 512185
Second Line :
City : LOS ANGELES
State : CA
Zip : 90051-0185
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2100 MAIN ST STE 300
Second Line :
City : HUNTINGTON BEACH
State : CA
Zip : 92648-2489
Country : US
Telephone Number : 714-252-9415
Fax Number : 714-963-8407
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2012
Last Update Date : 07/25/2024

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Directions to “ ALICIA ZIDE LCSW” Practice Location

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