Healthcare Provider Details

I. General information

NPI: 1255156568
Provider Name (Legal Business Name): PENNY MICHELLE ZELLMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 S ANITA DR
ORANGE CA
92868-3355
US

IV. Provider business mailing address

1320 W PEARL ST
ANAHEIM CA
92801-5941
US

V. Phone/Fax

Practice location:
  • Phone: 949-749-2500
  • Fax:
Mailing address:
  • Phone: 714-780-1174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number13290
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: