Healthcare Provider Details

I. General information

NPI: 1265602122
Provider Name (Legal Business Name): RON ZUCKERMAN MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SANCHEZ ST
SAN FRANCISCO CA
94114-1613
US

IV. Provider business mailing address

201 SANCHEZ ST
SAN FRANCISCO CA
94114-1613
US

V. Phone/Fax

Practice location:
  • Phone: 415-626-4610
  • Fax:
Mailing address:
  • Phone: 415-626-4610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC37689
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: