Provider Demographics
NPI:1497760169
Name:ZACKLER, LESTER M (MD)
Entity Type:Individual
Prefix:DR
First Name:LESTER
Middle Name:M
Last Name:ZACKLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13320 RIVERSIDE DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2502
Mailing Address - Country:US
Mailing Address - Phone:818-789-8488
Mailing Address - Fax:818-789-1204
Practice Address - Street 1:13320 RIVERSIDE DR
Practice Address - Street 2:SUITE 206
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2502
Practice Address - Country:US
Practice Address - Phone:818-789-8488
Practice Address - Fax:818-789-1204
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG443032084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA92479Medicare UPIN