Individual
LORI ZACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4834 LEHRER DR, SAN DIEGO, CA 92117-1360
(858) 775-7630
Mailing address
4834 LEHRER DR, SAN DIEGO, CA 92117-1360
(858) 775-7630
Taxonomy
Speciality
Code
Description
License number
State
225XG0600X
Gerontology Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT3225
CALIFORNIA BOARD OF OCCUPATIONAL THERAPY
—
Enumeration date
05/16/2018
Last updated
05/16/2018
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