Provider Demographics
NPI:1801837158
Name:ZINNER, NANCY DAVIS (PHD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:DAVIS
Last Name:ZINNER
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 1:24445 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6562
Mailing Address - Country:US
Mailing Address - Phone:310-375-7139
Mailing Address - Fax:310-373-8370
Practice Address - Street 1:24445 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6562
Practice Address - Country:US
Practice Address - Phone:310-375-7139
Practice Address - Fax:310-373-8370
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13072103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY130720Medicaid
CACP10372Medicare ID - Type Unspecified