Healthcare Provider Details

I. General information

NPI: 1861128977
Provider Name (Legal Business Name): CAMILA ANAHI ZALDUMBIDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 MERCHANT PL
NEWARK NJ
07105-2717
US

IV. Provider business mailing address

23 MERCHANT PL
NEWARK NJ
07105-2717
US

V. Phone/Fax

Practice location:
  • Phone: 973-902-8771
  • Fax:
Mailing address:
  • Phone: 973-902-8771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number15BC00125100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: