Provider Demographics
NPI:1891906731
Name:ZELNICK, MICHEL
Entity Type:Individual
Prefix:MR
First Name:MICHEL
Middle Name:
Last Name:ZELNICK
Suffix:
Gender:M
Credentials:
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 2512
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92038-2512
Mailing Address - Country:US
Mailing Address - Phone:858-337-8668
Mailing Address - Fax:
Practice Address - Street 1:8911 HERSCHEL AVE.
Practice Address - Street 2:STE 411
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4412
Practice Address - Country:US
Practice Address - Phone:858-337-8668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43267106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist