Healthcare Provider Details

I. General information

NPI: 1366713505
Provider Name (Legal Business Name): ANGELA N ZUCCARINO PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 WILSHIRE BLVD SUITE 670
LOS ANGELES CA
90010-2401
US

IV. Provider business mailing address

3550 WILSHIRE BLVD SUITE 670
LOS ANGELES CA
90010-2401
US

V. Phone/Fax

Practice location:
  • Phone: 213-384-7660
  • Fax: 213-384-2084
Mailing address:
  • Phone: 213-384-7660
  • Fax: 213-384-2084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY18258
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: