1639422009 NPI number — DR. VANESSA ZIZAK

Table of content: DR. VANESSA ZIZAK (NPI 1639422009)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639422009 NPI number — DR. VANESSA ZIZAK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZIZAK
Provider First Name:
VANESSA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639422009
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
VA LONG BEACH HEALTHCARE SYSTEM
Provider Second Line Business Mailing Address:
5901 EAST 7TH ST. MAILBOX 116B
Provider Business Mailing Address City Name:
LONG BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-826-8000
Provider Business Mailing Address Fax Number:
562-826-5679

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
VA LONG BEACH HEALTHCARE SYSTEM
Provider Second Line Business Practice Location Address:
5901 EAST 7TH ST. MAILBOX 116B
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-826-8000
Provider Business Practice Location Address Fax Number:
562-826-5679
Provider Enumeration Date:
10/22/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X , with the licence number:  PSY26871 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103T00000X , with the licence number: PSY26871 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103G00000X , with the licence number: 4334 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 4334 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)