MEDICARE: RONALD ZALIS M.F.T

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	37149	CA

General Provider Information

NPI Number	:	1881886414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD ZALIS M.F.T

Provider Business Mailing Address
First Line	:	655 S FLOWER ST
Second Line	:	368
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-2805
Country	:	US
Telephone Number	:	213-430-9180
Fax Number	:	213-430-9193

Provider Business Practice Location Address
First Line	:	5301 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-4038
Country	:	US
Telephone Number	:	213-430-9180
Fax Number	:	213-430-9193

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2007
Last Update Date	:	08/17/2007

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