Healthcare Provider Details

I. General information

NPI: 1376977140
Provider Name (Legal Business Name): SAM MEMAR ZIA MFT-I
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10200 SEPULVEDA BLVD STE 100
MISSION HILLS CA
91345-3316
US

IV. Provider business mailing address

1804 STONESGATE ST
THOUSAND OAKS CA
91361-1611
US

V. Phone/Fax

Practice location:
  • Phone: 323-879-9176
  • Fax:
Mailing address:
  • Phone: 323-879-9176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT106352
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: