Healthcare Provider Details

I. General information

NPI: 1083663538
Provider Name (Legal Business Name): MICHELE L ZUCKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2659 STATE ST STE 100
CARLSBAD CA
92008-1627
US

IV. Provider business mailing address

PO BOX 131747
CARLSBAD CA
92013-1747
US

V. Phone/Fax

Practice location:
  • Phone: 619-350-6290
  • Fax: 619-436-4739
Mailing address:
  • Phone: 193-506-2906
  • Fax: 267-425-9299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.084839
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number312011-01
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberT4095
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMD61181970
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberDR.0067384
License Number StateCO
# 6
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMD432542
License Number StatePA
# 7
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number35.084839
License Number StateOH
# 8
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number036.149430
License Number StateCA
# 9
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number036.149430
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: