Provider Demographics
NPI:1114933074
Name:NAGAR, ZIVA (PHD, RN)
Entity Type:Individual
Prefix:PROF
First Name:ZIVA
Middle Name:
Last Name:NAGAR
Suffix:
Gender:F
Credentials:PHD, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7729
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91327-7729
Mailing Address - Country:US
Mailing Address - Phone:818-361-7717
Mailing Address - Fax:
Practice Address - Street 1:11273 LAUREL CANYON BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-4300
Practice Address - Country:US
Practice Address - Phone:818-361-7717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13502103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY13502OtherLICENSE NUMBER
CA75-3139123OtherTIN NUMBER