Healthcare Provider Details

I. General information

NPI: 1205783271
Provider Name (Legal Business Name): ADALY MAZAKIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 WILSHIRE BLVD STE 211
SANTA MONICA CA
90403-2337
US

IV. Provider business mailing address

PO BOX 16262
ENCINO CA
91416-6262
US

V. Phone/Fax

Practice location:
  • Phone: 424-788-2826
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number160889
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: