Provider Demographics
NPI:1013559681
Name:ZIMMERMAN, DAVID J SR
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:ZIMMERMAN
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 DUTCH FLAT CT
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-1423
Mailing Address - Country:US
Mailing Address - Phone:707-712-5616
Mailing Address - Fax:
Practice Address - Street 1:201 DUTCH FLAT CT
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-1423
Practice Address - Country:US
Practice Address - Phone:707-712-5616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider