Provider Demographics
NPI:1619981230
Name:ZODKEVITCH, RONY (MD)
Entity Type:Individual
Prefix:
First Name:RONY
Middle Name:
Last Name:ZODKEVITCH
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:PO BOX 491670
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-8670
Mailing Address - Country:US
Mailing Address - Phone:310-826-2661
Mailing Address - Fax:
Practice Address - Street 1:9100 WILSHIRE BLVD
Practice Address - Street 2:SUITE 245
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3401
Practice Address - Country:US
Practice Address - Phone:310-826-2661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG559992084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry