Provider Demographics
NPI:1205484144
Name:ROZMID, ERICA VICTORIA (PHD)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:VICTORIA
Last Name:ROZMID
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:VICTORIA
Other - Last Name:ROZBRUCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11740 SAN VICENTE BLVD STE 109-169
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-6610
Mailing Address - Country:US
Mailing Address - Phone:310-853-3970
Mailing Address - Fax:
Practice Address - Street 1:1849 SAWTELLE BLVD STE 610
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7013
Practice Address - Country:US
Practice Address - Phone:310-853-3970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31999103T00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist