MEDICARE: BENJAMIN ZIMMERMAN MS BEHAVIORAL PSYCH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1790806099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN ZIMMERMAN MS BEHAVIORAL PSYCH

Provider Business Mailing Address
First Line	:	2235 GRANT RD STE 2
Second Line	:
City	:	LOS ALTOS
State	:	CA
Zip	:	94024-6959
Country	:	US
Telephone Number	:	650-237-9111
Fax Number	:	650-396-7575

Provider Business Practice Location Address
First Line	:	2235 GRANT RD STE 2
Second Line	:
City	:	LOS ALTOS
State	:	CA
Zip	:	94024-6959
Country	:	US
Telephone Number	:	650-237-9111
Fax Number	:	650-396-7575

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	07/08/2007

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