Healthcare Provider Details

I. General information

NPI: 1598240178
Provider Name (Legal Business Name): ZAKIYYAH JOHNICE ZIYADHYATT PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 09/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 ZANKER RD STE 230
SAN JOSE CA
95112-1129
US

IV. Provider business mailing address

1650 ZANKER RD STE 230
SAN JOSE CA
95112-1129
US

V. Phone/Fax

Practice location:
  • Phone: 408-590-8655
  • Fax:
Mailing address:
  • Phone: 408-590-8655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number117679
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: