Healthcare Provider Details

I. General information

NPI: 1619981230
Provider Name (Legal Business Name): RONY ZODKEVITCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 WILSHIRE BLVD SUITE 245
BEVERLY HILLS CA
90212-3401
US

IV. Provider business mailing address

PO BOX 491670
LOS ANGELES CA
90049-8670
US

V. Phone/Fax

Practice location:
  • Phone: 310-826-2661
  • Fax:
Mailing address:
  • Phone: 310-826-2661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberG55999
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: