Healthcare Provider Details

I. General information

NPI: 1528399060
Provider Name (Legal Business Name): LUDMILA ZAYTSEV PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2010
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15335 MORRISON ST STE 205
SHERMAN OAKS CA
91403-1585
US

IV. Provider business mailing address

15335 MORRISON ST STE 205
SHERMAN OAKS CA
91403-1585
US

V. Phone/Fax

Practice location:
  • Phone: 323-682-8225
  • Fax: 323-729-3829
Mailing address:
  • Phone: 323-682-8225
  • Fax: 323-729-3829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number23050
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number23050
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: