Healthcare Provider Details

I. General information

NPI: 1275740110
Provider Name (Legal Business Name): NATHAN JEROME ZILBERG PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 TAMALPAIS DR SUITE 100
CORTE MADERA CA
94925-1558
US

IV. Provider business mailing address

520 TAMALPAIS DR SUITE 100
CORTE MADERA CA
94925-1558
US

V. Phone/Fax

Practice location:
  • Phone: 415-927-4421
  • Fax: 415-464-8774
Mailing address:
  • Phone: 415-927-4421
  • Fax: 415-464-8774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY5533
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: