Healthcare Provider Details

I. General information

NPI: 1376971432
Provider Name (Legal Business Name): NICOLE ZOKAEEM PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2013
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12011 SAN VICENTE BLVD STE 200
LOS ANGELES CA
90049-4944
US

IV. Provider business mailing address

12011 SAN VICENTE BLVD STE 200
LOS ANGELES CA
90049-4944
US

V. Phone/Fax

Practice location:
  • Phone: 310-853-2236
  • Fax:
Mailing address:
  • Phone: 310-853-2236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY30918
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: