=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497087969
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YANNI ZACK
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2010
-----------------------------------------------------
Last Update Date | 02/08/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19231 VICTORY BLVD SUITE 554
-----------------------------------------------------
City | RESEDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91335-6308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-776-1755
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9212 LIME AVE
-----------------------------------------------------
City | CALIFORNIA CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93505-3546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-916-4749
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------