Healthcare Provider Details

I. General information

NPI: 1942055116
Provider Name (Legal Business Name): ZYLAH DIOR ROBERTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21600 OXNARD ST STE 200
WOODLAND HILLS CA
91367-4971
US

IV. Provider business mailing address

7000 AUBURN ST APT 4
BAKERSFIELD CA
93306-7222
US

V. Phone/Fax

Practice location:
  • Phone: 877-206-1009
  • Fax:
Mailing address:
  • Phone: 661-800-9035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: