1942375811 NPI number — BEDEANIA RENEE ZUREK LCSW 74215

Table of content: BEDEANIA RENEE ZUREK LCSW 74215 (NPI 1942375811)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942375811 NPI number — BEDEANIA RENEE ZUREK LCSW 74215

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZUREK
Provider First Name:
BEDEANIA
Provider Middle Name:
RENEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW 74215
Provider Gender Code:
F

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:
1942375811
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 459
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IMPERIAL BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91933-0459
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-429-3733
Provider Business Mailing Address Fax Number:
619-628-5550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
949 PALM AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IMPERIAL BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91932-1503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-429-3733
Provider Business Practice Location Address Fax Number:
619-628-5550
Provider Enumeration Date:
11/22/2006

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: 1041C0700X , with the licence number:  74215 , 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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