Healthcare Provider Details

I. General information

NPI: 1174682918
Provider Name (Legal Business Name): TOM E ZINKLE PH. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 WYNDHAM DR
SACRAMENTO CA
95823-4913
US

IV. Provider business mailing address

7300 WYNDHAM DR
SACRAMENTO CA
95823-4913
US

V. Phone/Fax

Practice location:
  • Phone: 916-525-6213
  • Fax:
Mailing address:
  • Phone: 916-525-6213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5332
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: