Provider Demographics
NPI:1659417970
Name:ZOMBER, PATRICIA A (PHD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:ZOMBER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4640 ADMIRALTY WAY
Mailing Address - Street 2:SUITE 318
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6621
Mailing Address - Country:US
Mailing Address - Phone:310-822-0109
Mailing Address - Fax:310-822-1240
Practice Address - Street 1:4640 ADMIRALTY WAY
Practice Address - Street 2:SUITE 318
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6621
Practice Address - Country:US
Practice Address - Phone:310-822-0109
Practice Address - Fax:310-822-1240
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9176103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical