Healthcare Provider Details

I. General information

NPI: 1780004226
Provider Name (Legal Business Name): RONIT HAVIVA ZADIKANY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2014
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 WILSHIRE BLVD STE 200
BEVERLY HILLS CA
90211-3128
US

IV. Provider business mailing address

4523 ESTRONDO DR
ENCINO CA
91436-3229
US

V. Phone/Fax

Practice location:
  • Phone: 310-247-9614
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA140699
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA140699
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: