Provider Demographics
NPI:1447738216
Name:ZERVOULAKOS, LEI RAIZA
Entity Type:Individual
Prefix:MISS
First Name:LEI RAIZA
Middle Name:
Last Name:ZERVOULAKOS
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 1:1926 BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2402
Mailing Address - Country:US
Mailing Address - Phone:213-353-1140
Mailing Address - Fax:
Practice Address - Street 1:1926 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2402
Practice Address - Country:US
Practice Address - Phone:213-353-1140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Single Specialty