Healthcare Provider Details

I. General information

NPI: 1609050947
Provider Name (Legal Business Name): CYNTHIA OVALLE PLOTKIN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5743 CORSA AVE STE 125
WESTLAKE VILLAGE CA
91362-6462
US

IV. Provider business mailing address

5743 CORSA AVE STE 125
WESTLAKE VILLAGE CA
91362-6462
US

V. Phone/Fax

Practice location:
  • Phone: 805-493-5155
  • Fax:
Mailing address:
  • Phone: 805-493-5155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY16332
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: