Provider Demographics
NPI:1144787557
Name:ISRAELY, ZAHAVA
Entity Type:Individual
Prefix:DR
First Name:ZAHAVA
Middle Name:
Last Name:ISRAELY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5680 SAWTELLE BLVD
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-5554
Mailing Address - Country:US
Mailing Address - Phone:310-433-2855
Mailing Address - Fax:
Practice Address - Street 1:16250 VENTURA BLV ENCINO
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-9143
Practice Address - Country:US
Practice Address - Phone:310-433-2855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMP24478156FX1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1201XEye and Vision Services ProvidersTechnician/TechnologistOptometric Assistant