Provider Demographics
NPI:1730530684
Name:ZINIK, GARY (PHD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:ZINIK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 S VICTORIA AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6551
Mailing Address - Country:US
Mailing Address - Phone:805-650-3327
Mailing Address - Fax:
Practice Address - Street 1:1280 S VICTORIA AVE STE 230
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6551
Practice Address - Country:US
Practice Address - Phone:805-650-3327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10262103TF0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical