Healthcare Provider Details

I. General information

NPI: 1205268422
Provider Name (Legal Business Name): EDIA TZADIKARIO PHD MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2013
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 KENDALL AVE
PALO ALTO CA
94306-2726
US

IV. Provider business mailing address

3790 EL CAMINO REAL STE 201
PALO ALTO CA
94306-3314
US

V. Phone/Fax

Practice location:
  • Phone: 650-441-9173
  • Fax:
Mailing address:
  • Phone: 650-441-9173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: