Healthcare Provider Details

I. General information

NPI: 1295240893
Provider Name (Legal Business Name): DORIS Z PAKOZDI-PAST LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W 6TH ST
SAN PEDRO CA
90731-3316
US

IV. Provider business mailing address

222 W 6TH ST
SAN PEDRO CA
90731-3316
US

V. Phone/Fax

Practice location:
  • Phone: 310-833-3135
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number114245
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number130769
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: