Healthcare Provider Details

I. General information

NPI: 1437486412
Provider Name (Legal Business Name): ZACHARY DANE GINDER PSYD, MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2009
Last Update Date: 06/28/2025
Certification Date: 06/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19314 JESSE LN STE 200
RIVERSIDE CA
92508-5070
US

IV. Provider business mailing address

19314 JESSE LN STE 200
RIVERSIDE CA
92508-5070
US

V. Phone/Fax

Practice location:
  • Phone: 909-799-3777
  • Fax:
Mailing address:
  • Phone: 909-799-3777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35958
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: