Healthcare Provider Details

I. General information

NPI: 1205030343
Provider Name (Legal Business Name): NANCY ALINE ZOSS MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 MARCO PLACE
VENICE CA
90291
US

IV. Provider business mailing address

705 MARCO PLACE
VENICE CA
90291
US

V. Phone/Fax

Practice location:
  • Phone: 310-281-7569
  • Fax: 310-821-1505
Mailing address:
  • Phone: 310-281-7569
  • Fax: 310-821-1505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC39587
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: