Healthcare Provider Details

I. General information

NPI: 1366479131
Provider Name (Legal Business Name): STEVEN N ZUDIKER PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8760 CUYAMACA ST 211
SANTEE CA
92071-6210
US

IV. Provider business mailing address

4486 BANCROFT ST
SAN DIEGO CA
92116-4567
US

V. Phone/Fax

Practice location:
  • Phone: 619-596-9892
  • Fax:
Mailing address:
  • Phone: 619-370-2956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY19051
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: