Provider Demographics
NPI:1942590740
Name:LESTER M. ZACKLER, M.D., INC
Entity Type:Organization
Organization Name:LESTER M. ZACKLER, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LESTER
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZACKLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-789-8488
Mailing Address - Street 1:13320 RIVERSIDE DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2502
Mailing Address - Country:US
Mailing Address - Phone:818-789-8488
Mailing Address - Fax:818-789-1204
Practice Address - Street 1:13320 RIVERSIDE DR
Practice Address - Street 2:SUITE 206
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2502
Practice Address - Country:US
Practice Address - Phone:818-789-8488
Practice Address - Fax:818-789-1204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44303103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA92479Medicare UPIN