Provider Demographics
NPI:1578349569
Name:MUDROVCIC, ZANETA
Entity Type:Individual
Prefix:
First Name:ZANETA
Middle Name:
Last Name:MUDROVCIC
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 1:12538 VENICE BLVD APT 5
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-3736
Mailing Address - Country:US
Mailing Address - Phone:424-324-8998
Mailing Address - Fax:
Practice Address - Street 1:16800 DEVONSHIRE ST STE 212
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-7409
Practice Address - Country:US
Practice Address - Phone:323-459-4968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23313103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical