Healthcare Provider Details

I. General information

NPI: 1417042870
Provider Name (Legal Business Name): JENNIFER LEE ZIMMERMAN P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 FLORIDA AVE.
MODESTO CA
95352
US

IV. Provider business mailing address

1441 FLORIDA AVE
MODESTO CA
95350-4404
US

V. Phone/Fax

Practice location:
  • Phone: 209-578-1211
  • Fax:
Mailing address:
  • Phone: 209-576-3601
  • Fax: 209-576-3680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA10924
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: