1952709933 NPI number — GERALDINE CORNELIA ZWICKER RD CDE

Table of content: GERALDINE CORNELIA ZWICKER RD CDE (NPI 1952709933)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952709933 NPI number — GERALDINE CORNELIA ZWICKER RD CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZWICKER
Provider First Name:
GERALDINE
Provider Middle Name:
CORNELIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RD CDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FILET
Provider Other First Name:
GERI
Provider Other Middle Name:
CORNELIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952709933
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 NORTH STATE STREET
Provider Second Line Business Mailing Address:
1 PT RM 2C2 115
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-409-6979
Provider Business Mailing Address Fax Number:
323-441-8226

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2010 ZONAL AVENUE
Provider Second Line Business Practice Location Address:
5E OPD
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-226-4556
Provider Business Practice Location Address Fax Number:
323-226-8117
Provider Enumeration Date:
12/08/2014

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: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 398572 . This is a "COMMISION ON DIETETIC REGISTRATION" identifier . This identifiers is of the category "OTHER".




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