Healthcare Provider Details

I. General information

NPI: 1972479673
Provider Name (Legal Business Name): ZUMWALT NEUROPSYCHOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2025
Last Update Date: 10/11/2025
Certification Date: 10/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21062 BROOKHURST ST STE 201
HUNTINGTON BEACH CA
92646-7404
US

IV. Provider business mailing address

21062 BROOKHURST ST STE 201
HUNTINGTON BEACH CA
92646-7404
US

V. Phone/Fax

Practice location:
  • Phone: 714-514-4742
  • Fax:
Mailing address:
  • Phone: 714-514-4742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: RICHARD ZUMWALT
Title or Position: OWNER
Credential: PHD
Phone: 714-514-4742