1366940504 NPI number — NEW LEAF COUNSELING AND PSYCHOTHERAPY

Table of content: CHRISTINA RENE ZAMORA OD (NPI 1174147383)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366940504 NPI number — NEW LEAF COUNSELING AND PSYCHOTHERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW LEAF COUNSELING AND PSYCHOTHERAPY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1366940504
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1030 2N STREET
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
SANTA ROSA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-387-4146
Provider Business Mailing Address Fax Number:
707-843-5608

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1030 2N STREET
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SANTA ROSA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-387-4146
Provider Business Practice Location Address Fax Number:
707-843-5608
Provider Enumeration Date:
01/23/2018

Additional Information

Authorized Official

Authorized Official Last Name:
WHITLOCK
Authorized Official First Name:
GAYLE
Authorized Official Middle Name:
JANET
Authorized Official Title or Position:
OWNER/THERAPIST
Authorized Official Telephone Number:
707-387-8414

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  84009 , 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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