Healthcare Provider Details

I. General information

NPI: 1609329291
Provider Name (Legal Business Name): DZOVAK KAZANDJIAN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2016
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30495 CANWOOD ST STE 101
AGOURA HILLS CA
91301-4331
US

IV. Provider business mailing address

6101 OWENSMOUTH AVE # 6062
WOODLAND HILLS CA
91367-5136
US

V. Phone/Fax

Practice location:
  • Phone: 818-707-7366
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY31603
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: