Provider Demographics
NPI:1497818207
Name:ZAGNOEV, DAPHNE T (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DAPHNE
Middle Name:T
Last Name:ZAGNOEV
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4281 KATELLA AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3500
Mailing Address - Country:US
Mailing Address - Phone:714-226-9770
Mailing Address - Fax:714-226-9776
Practice Address - Street 1:4281 KATELLA AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3500
Practice Address - Country:US
Practice Address - Phone:714-226-9770
Practice Address - Fax:714-226-9776
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19921103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical