Healthcare Provider Details

I. General information

NPI: 1750008959
Provider Name (Legal Business Name): JESSICA ZUCKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PACIFIC COAST HWY STE 103
HERMOSA BEACH CA
90254-2700
US

IV. Provider business mailing address

318 AVENUE I # 198
REDONDO BEACH CA
90277-5601
US

V. Phone/Fax

Practice location:
  • Phone: 310-303-9132
  • Fax:
Mailing address:
  • Phone: 949-525-0197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: