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General NPI Number Information
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NPI Number | 1437635877
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Entity Type | Individual
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Provider Name | TEODOR DMYTRO ZELENSKYY
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Gender | Male
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Dates
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Enumeration Date | 07/18/2018
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 5669 GIBRALTAR DR
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City | PLEASANTON
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State | CA
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Zip | 94588-8547
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Country | US
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Telephone | 925-551-6740
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Fax |
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Provider Business Mailing Address
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Address Line | 4300 BLACK AVE PO BOX 14
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City | PLEASANTON
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State | CA
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Zip | 94566
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Country | US
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Telephone | 925-529-2013
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 153090
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License Number State | CA
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