Healthcare Provider Details

I. General information

NPI: 1811822885
Provider Name (Legal Business Name): SIMON ZACHARY CARMACK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1252 MANZANITA AVE
CHICO CA
95926-7302
US

IV. Provider business mailing address

1970 WILD OAK LN
CHICO CA
95928-4000
US

V. Phone/Fax

Practice location:
  • Phone: 916-288-9882
  • Fax: 888-870-9642
Mailing address:
  • Phone: 530-966-8695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: