Healthcare Provider Details

I. General information

NPI: 1821844515
Provider Name (Legal Business Name): LISA MICHELLE ZEITLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 5209
WEST HILLS CA
91308-5209
US

IV. Provider business mailing address

PO BOX 5209
WEST HILLS CA
91308-5209
US

V. Phone/Fax

Practice location:
  • Phone: 818-606-3436
  • Fax:
Mailing address:
  • Phone: 818-606-3436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number100903
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: