Healthcare Provider Details

I. General information

NPI: 1629082631
Provider Name (Legal Business Name): KAREN ZICCARDI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10900 183RD ST #171
CERRITOS CA
90703-5342
US

IV. Provider business mailing address

5514 STEVELY AVE
LAKEWOOD CA
90713-1746
US

V. Phone/Fax

Practice location:
  • Phone: 562-920-2599
  • Fax:
Mailing address:
  • Phone: 562-920-2599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number28831
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: