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General NPI Number Information
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NPI Number | 1073122776
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Entity Type | Individual
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Provider Name | MICHAEL PEZZULLO LMFT
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Gender | Male
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Dates
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Enumeration Date | 07/28/2020
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Last Update Date | 07/28/2020
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Provider Practice Location Address
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Address Line | 8271 MELROSE AVE STE 102
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City | LOS ANGELES
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State | CA
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Zip | 90046-6800
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Country | US
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Telephone | 213-640-9788
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Fax |
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Provider Business Mailing Address
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Address Line | 10055 REEVESBURY DR
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-1422
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Country | US
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Telephone | 347-886-3710
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 120508
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License Number State | CA
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