Healthcare Provider Details

I. General information

NPI: 1962850404
Provider Name (Legal Business Name): KATELYN JESSIE ZIRKUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 05/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CROW CANYON CT. STE# 100
SAN RAMON CA
94583
US

IV. Provider business mailing address

1 CROW CANYON CT. STE# 100
SAN RAMON CA
94583
US

V. Phone/Fax

Practice location:
  • Phone: 888-531-8385
  • Fax: 925-264-1902
Mailing address:
  • Phone: 888-531-8385
  • Fax: 925-264-1902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: