Healthcare Provider Details

I. General information

NPI: 1336261833
Provider Name (Legal Business Name): MICHAEL D. ZIMMERMAN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 POLLASKY AVE SUITE 210
CLOVIS CA
93612-1875
US

IV. Provider business mailing address

642 POLLASKY AVE SUITE 210
CLOVIS CA
93612-1875
US

V. Phone/Fax

Practice location:
  • Phone: 559-298-5368
  • Fax: 559-298-5378
Mailing address:
  • Phone: 559-298-5368
  • Fax: 559-298-5378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY10502
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY10502
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY10502
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPSY10502
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY10502
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY10502
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: