Provider Demographics
NPI:1477572725
Name:PLOTKIN, DAVID P (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:PLOTKIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16055 VENTURA BLVD STE 715
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2610
Mailing Address - Country:US
Mailing Address - Phone:310-470-9994
Mailing Address - Fax:310-882-6820
Practice Address - Street 1:16055 VENTURA BLVD STE 715
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2610
Practice Address - Country:US
Practice Address - Phone:310-470-9994
Practice Address - Fax:310-882-6820
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19818103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP19818Medicare PIN