Healthcare Provider Details

I. General information

NPI: 1033689468
Provider Name (Legal Business Name): ELIZABETH ZACHARIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7750 COLLEGE TOWN DR STE 204
SACRAMENTO CA
95826-2362
US

IV. Provider business mailing address

4221 WILSHIRE BLVD STE 300
LOS ANGELES CA
90010-3512
US

V. Phone/Fax

Practice location:
  • Phone: 888-428-3223
  • Fax:
Mailing address:
  • Phone: 888-428-3223
  • Fax: 323-866-1881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-61609
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: