Healthcare Provider Details

I. General information

NPI: 1851618656
Provider Name (Legal Business Name): JOHN JOSEPH ZANE M.D.,J.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 05/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78509 PALM TREE AVE
PALM DESERT CA
92211-1853
US

IV. Provider business mailing address

78509 PALM TREE AVE
PALM DESERT CA
92211-1853
US

V. Phone/Fax

Practice location:
  • Phone: 760-832-5794
  • Fax:
Mailing address:
  • Phone: 760-832-5794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number101YMO88OOX
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: