Healthcare Provider Details

I. General information

NPI: 1407147887
Provider Name (Legal Business Name): DAVID BRANDON ZINKE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 04/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 TERRACINA BLVD SUITE 204
REDLANDS CA
92373-4870
US

IV. Provider business mailing address

255 TERRACINA BLVD SUITE 204
REDLANDS CA
92373-4870
US

V. Phone/Fax

Practice location:
  • Phone: 909-798-1763
  • Fax:
Mailing address:
  • Phone: 909-798-1763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 24346
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: