Healthcare Provider Details

I. General information

NPI: 1881614626
Provider Name (Legal Business Name): BILL ZIKA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 04/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 FOREST AVE SUITE 3
PACIFIC GROVE CA
93950-4264
US

IV. Provider business mailing address

621 FOREST AVE STE 5
PACIFIC GROVE CA
93950-4264
US

V. Phone/Fax

Practice location:
  • Phone: 831-595-0410
  • Fax: 831-647-9446
Mailing address:
  • Phone: 831-595-0410
  • Fax: 831-647-9446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 13091
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: