Individual
JENNIFER SARAH ZIDOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1770 E 118TH ST, LOS ANGELES, CA 90059-2518
(323) 249-2950
(323) 249-2970
Mailing address
3737 MARTIN LUTHER KING JR BLVD, 550, LYNWOOD, CA 90262-3513
(310) 609-3890
(310) 609-0301
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
191593453
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01245407
MEDICAL
CA
Enumeration date
10/29/2012
Last updated
10/29/2012
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