MEDICARE: SUZANNE MARIE ZUMWALT CERTIFIED FCT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	175T00000X	Peer Specialist	EDRLZNSVJIBWPFADM	CA

General Provider Information

NPI Number	:	1184214348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE MARIE ZUMWALT CERTIFIED FCT

Provider Business Mailing Address
First Line	:	79016 BAYSIDE CT
Second Line	:
City	:	BERMUDA DUNES
State	:	CA
Zip	:	92203-1528
Country	:	US
Telephone Number	:	442-666-3217
Fax Number	:	760-616-7035

Provider Business Practice Location Address
First Line	:	73255 EL PASEO STE 11
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-4249
Country	:	US
Telephone Number	:	442-666-3217
Fax Number	:	760-616-7035

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2021
Last Update Date	:	09/03/2025

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