Healthcare Provider Details

I. General information

NPI: 1700916616
Provider Name (Legal Business Name): REBECCA L. ZOLOTT L.CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3853 ROSECRANS ST
SAN DIEGO CA
92110-3115
US

IV. Provider business mailing address

6520 LOCHMOOR DR
SAN DIEGO CA
92120-3226
US

V. Phone/Fax

Practice location:
  • Phone: 619-692-8207
  • Fax: 619-542-4060
Mailing address:
  • Phone: 619-692-8207
  • Fax: 619-542-4060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS15364
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: