Healthcare Provider Details

I. General information

NPI: 1770847451
Provider Name (Legal Business Name): MATTHEW ZELEDON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 MAIDU AVE
NEVADA CITY CA
95959-8600
US

IV. Provider business mailing address

925 MAIDU AVE
NEVADA CITY CA
95959-8600
US

V. Phone/Fax

Practice location:
  • Phone: 530-265-1523
  • Fax:
Mailing address:
  • Phone: 530-265-1523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number125250
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: