Healthcare Provider Details

I. General information

NPI: 1861475865
Provider Name (Legal Business Name): THEODORE ZWERDLING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 07/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5125 SKYWAY
PARADISE CA
95969
US

IV. Provider business mailing address

5125 SKYWAY
PARADISE CA
95969-5624
US

V. Phone/Fax

Practice location:
  • Phone: 530-872-2000
  • Fax: 530-332-1049
Mailing address:
  • Phone: 530-872-2000
  • Fax: 530-332-1049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberG52223
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG52223
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: