Healthcare Provider Details

I. General information

NPI: 1467367201
Provider Name (Legal Business Name): ZENUS EARL DISMUKES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 PICO BLVD
SANTA MONICA CA
90405-1416
US

IV. Provider business mailing address

909 PICO BLVD
SANTA MONICA CA
90405-1326
US

V. Phone/Fax

Practice location:
  • Phone: 310-314-6200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number137348
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: