Healthcare Provider Details

I. General information

NPI: 1184214348
Provider Name (Legal Business Name): SUZANNE MARIE ZUMWALT CERTIFIED FCT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73255 EL PASEO STE 11
PALM DESERT CA
92260-4249
US

IV. Provider business mailing address

79016 BAYSIDE CT
BERMUDA DUNES CA
92203-1528
US

V. Phone/Fax

Practice location:
  • Phone: 442-666-3217
  • Fax: 760-616-7035
Mailing address:
  • Phone: 442-666-3217
  • Fax: 760-616-7035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberEDRLZNSVJIBWPFADM
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: