Healthcare Provider Details

I. General information

NPI: 1558805853
Provider Name (Legal Business Name): DINKO MICHAEL ZIDARICH M.A., LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2016
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8271 MELROSE AVE STE 102
LOS ANGELES CA
90046-6800
US

IV. Provider business mailing address

1155 N LA CIENEGA BLVD SUITE 206
WEST HOLLYWOOD CA
90069-2457
US

V. Phone/Fax

Practice location:
  • Phone: 424-226-2554
  • Fax:
Mailing address:
  • Phone: 424-226-2554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT97181
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: