Healthcare Provider Details

I. General information

NPI: 1417821109
Provider Name (Legal Business Name): MR. JACK ZEMBSCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2025
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3081 TEAGARDEN ST
SAN LEANDRO CA
94577-5720
US

IV. Provider business mailing address

10 HAMMOND PL
MORAGA CA
94556-1812
US

V. Phone/Fax

Practice location:
  • Phone: 510-347-4620
  • Fax:
Mailing address:
  • Phone: 925-464-3230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: