Provider Demographics
NPI:1821673740
Name:DEUTSCH-ZAKARIN, GINA
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:DEUTSCH-ZAKARIN
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 1:12921 EVANSTON ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-3714
Mailing Address - Country:US
Mailing Address - Phone:310-434-9505
Mailing Address - Fax:
Practice Address - Street 1:12921 EVANSTON ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-3714
Practice Address - Country:US
Practice Address - Phone:310-434-9505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT30614106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist