1164724175 NPI number — DR. ELLEN MARY ZONE DD, LMFT, MSW, MA

Table of content: DR. ELLEN MARY ZONE DD, LMFT, MSW, MA (NPI 1164724175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164724175 NPI number — DR. ELLEN MARY ZONE DD, LMFT, MSW, MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZONE
Provider First Name:
ELLEN
Provider Middle Name:
MARY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DD, LMFT, MSW, MA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZONE
Provider Other First Name:
ELENA
Provider Other Middle Name:
MARY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
TDD, LMFT, MSW, MA
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1164724175
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
155 ROSEBAY DR
Provider Second Line Business Mailing Address:
UNIT 22
Provider Business Mailing Address City Name:
ENCINITAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92024-3333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-805-6731
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
155 ROSEBAY DR
Provider Second Line Business Practice Location Address:
UNIT 22
Provider Business Practice Location Address City Name:
ENCINITAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92024-3333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-805-6731
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/23/2010

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:  MFC 15042 , 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)





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