Healthcare Provider Details

I. General information

NPI: 1861950487
Provider Name (Legal Business Name): ANNA ZUCKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 S C ST
LOMPOC CA
93436-6924
US

IV. Provider business mailing address

901 N F ST
LOMPOC CA
93436-4136
US

V. Phone/Fax

Practice location:
  • Phone: 805-741-7853
  • Fax: 805-357-5372
Mailing address:
  • Phone: 805-588-4410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: