Healthcare Provider Details

I. General information

NPI: 1578601480
Provider Name (Legal Business Name): VERA ZHUKOV LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1195 MAGNOLIA AVE
CORONA CA
92879-3202
US

IV. Provider business mailing address

1195 MAGNOLIA AVE
CORONA CA
92879-3202
US

V. Phone/Fax

Practice location:
  • Phone: 951-273-0608
  • Fax: 951-273-1718
Mailing address:
  • Phone: 951-273-0608
  • Fax: 951-273-1718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number40826
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: