Healthcare Provider Details

I. General information

NPI: 1235335837
Provider Name (Legal Business Name): ZUK PSYCHOLOGY APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 LAUREL ST
SAN DIEGO CA
92101-1630
US

IV. Provider business mailing address

311 LAUREL ST
SAN DIEGO CA
92101-1630
US

V. Phone/Fax

Practice location:
  • Phone: 858-200-5671
  • Fax: 619-231-1050
Mailing address:
  • Phone: 858-200-5671
  • Fax: 619-231-1050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY19892
License Number StateCA

VIII. Authorized Official

Name: DR. ILAN ZUK
Title or Position: OWNER
Credential: PH.D.
Phone: 858-200-5671