Healthcare Provider Details

I. General information

NPI: 1659417970
Provider Name (Legal Business Name): PATRICIA A ZOMBER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4640 ADMIRALTY WAY SUITE 318
MARINA DEL REY CA
90292-6621
US

IV. Provider business mailing address

4640 ADMIRALTY WAY SUITE 318
MARINA DEL REY CA
90292-6621
US

V. Phone/Fax

Practice location:
  • Phone: 310-822-0109
  • Fax: 310-822-1240
Mailing address:
  • Phone: 310-822-0109
  • Fax: 310-822-1240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY9176
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: