=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861475865
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THEODORE ZWERDLING MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2005
-----------------------------------------------------
Last Update Date | 07/23/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5125 SKYWAY
-----------------------------------------------------
City | PARADISE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95969
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-872-2000
-----------------------------------------------------
Fax | 530-332-1049
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5125 SKYWAY
-----------------------------------------------------
City | PARADISE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95969-5624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-872-2000
-----------------------------------------------------
Fax | 530-332-1049
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080P0207X
-----------------------------------------------------
Taxonomy Name | Pediatric Hematology & Oncology Physician
-----------------------------------------------------
License Number | G52223
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | G52223
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------