Provider Demographics
NPI:1497087969
Name:ZACK, YANNI
Entity Type:Individual
Prefix:
First Name:YANNI
Middle Name:
Last Name:ZACK
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 1:9212 LIME AVE
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:93505-3546
Mailing Address - Country:US
Mailing Address - Phone:661-916-4749
Mailing Address - Fax:
Practice Address - Street 1:19231 VICTORY BLVD
Practice Address - Street 2:SUITE 554
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-6308
Practice Address - Country:US
Practice Address - Phone:818-776-1755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACMM70956FMedicaid
CA196856000Medicaid