Healthcare Provider Details

I. General information

NPI: 1659113173
Provider Name (Legal Business Name): ZIZMOR MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935A ADDISON ST STE 200
BERKELEY CA
94704-1101
US

IV. Provider business mailing address

1935A ADDISON ST STE 200
BERKELEY CA
94704-1101
US

V. Phone/Fax

Practice location:
  • Phone: 341-217-8411
  • Fax:
Mailing address:
  • Phone: 341-217-8411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL JEFFREY ZIZMOR
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 341-222-3800