Healthcare Provider Details

I. General information

NPI: 1639656812
Provider Name (Legal Business Name): ZACHARY LOSSING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ZACK LOSSING

II. Dates (important events)

Enumeration Date: 07/20/2018
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7986 DAGGET ST
SAN DIEGO CA
92111-2321
US

IV. Provider business mailing address

7986 DAGGET ST
SAN DIEGO CA
92111-2321
US

V. Phone/Fax

Practice location:
  • Phone: 858-300-0460
  • Fax:
Mailing address:
  • Phone: 858-300-0460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT151253
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: