Healthcare Provider Details

I. General information

NPI: 1477572725
Provider Name (Legal Business Name): DAVID PAUL PLOTKIN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16055 VENTURA BLVD STE 715
ENCINO CA
91436-2610
US

IV. Provider business mailing address

16055 VENTURA BLVD STE 715
ENCINO CA
91436-2610
US

V. Phone/Fax

Practice location:
  • Phone: 310-470-9994
  • Fax: 310-882-6820
Mailing address:
  • Phone: 310-308-7535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY19818
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: