Provider Demographics
NPI:1639422009
Name:ZIZAK, VANESSA
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:
Last Name:ZIZAK
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:VA LONG BEACH HEALTHCARE SYSTEM
Mailing Address - Street 2:5901 EAST 7TH ST. MAILBOX 116B
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90822
Mailing Address - Country:US
Mailing Address - Phone:562-826-8000
Mailing Address - Fax:562-826-5679
Practice Address - Street 1:VA LONG BEACH HEALTHCARE SYSTEM
Practice Address - Street 2:5901 EAST 7TH ST. MAILBOX 116B
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90822
Practice Address - Country:US
Practice Address - Phone:562-826-8000
Practice Address - Fax:562-826-5679
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26871103G00000X, 103T00000X
AZ4334103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical