Provider Demographics
NPI:1932267234
Name:ZIGMAN, EDEN L (PHD)
Entity Type:Individual
Prefix:
First Name:EDEN
Middle Name:L
Last Name:ZIGMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11901 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 504
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2767
Mailing Address - Country:US
Mailing Address - Phone:310-451-9902
Mailing Address - Fax:310-451-9902
Practice Address - Street 1:2001 S BARRINGTON AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5363
Practice Address - Country:US
Practice Address - Phone:310-451-9902
Practice Address - Fax:310-451-9902
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12796103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY127960Medicaid
CAPSY127960Medicaid
CP12796Medicare ID - Type Unspecified