Healthcare Provider Details

I. General information

NPI: 1114849577
Provider Name (Legal Business Name): JOSE ZAMUDIO ZAMUDIO MSW, PPSC, CWA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2249 DOBERN AVE
SAN JOSE CA
95116-3405
US

IV. Provider business mailing address

2249 DOBERN AVE
SAN JOSE CA
95116-3405
US

V. Phone/Fax

Practice location:
  • Phone: 408-824-5180
  • Fax:
Mailing address:
  • Phone: 408-824-5180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: