1154341006 NPI number — DR. ANTHONY JOHN ZIMBARDI JR. PSYD

Table of content: DR. ANTHONY JOHN ZIMBARDI JR. PSYD (NPI 1154341006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154341006 NPI number — DR. ANTHONY JOHN ZIMBARDI JR. PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZIMBARDI
Provider First Name:
ANTHONY
Provider Middle Name:
JOHN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
PSYD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154341006
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3121 ELLINGTON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90068-1738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-351-4531
Provider Business Mailing Address Fax Number:
323-848-9974

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8235 SANTA MONICA BLVD
Provider Second Line Business Practice Location Address:
PENTHOUSE SUITE
Provider Business Practice Location Address City Name:
WEST HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90046-5914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-851-1304
Provider Business Practice Location Address Fax Number:
323-848-9974
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  33579 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com