Healthcare Provider Details

I. General information

NPI: 1356566400
Provider Name (Legal Business Name): XIMENA M. ZURITA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 FREMONT AVE SUITE #202
LOS ALTOS CA
94024-6024
US

IV. Provider business mailing address

919 FREMONT AVE SUITE #202
LOS ALTOS CA
94024-6024
US

V. Phone/Fax

Practice location:
  • Phone: 650-428-1840
  • Fax: 650-948-6263
Mailing address:
  • Phone: 650-428-1840
  • Fax: 650-948-6263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY15102
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: