Provider Demographics
NPI:1245277342
Name:NETZEN, LORI (CMF)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:
Last Name:NETZEN
Suffix:
Gender:F
Credentials:CMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16060 VENTURA BLVD.
Mailing Address - Street 2:SUITE 105-194
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2761
Mailing Address - Country:US
Mailing Address - Phone:818-481-5860
Mailing Address - Fax:818-728-6704
Practice Address - Street 1:1320 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90028-7609
Practice Address - Country:US
Practice Address - Phone:323-469-4299
Practice Address - Fax:323-460-2035
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC22236174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5718150001Medicare NSC
CA5718150002Medicare NSC