Provider Demographics
NPI:1104020478
Name:ZELLNER, JEFFREY ALLAN
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALLAN
Last Name:ZELLNER
Suffix:
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 1:764 PATRICIA LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-6503
Mailing Address - Country:US
Mailing Address - Phone:530-448-9550
Mailing Address - Fax:530-544-0140
Practice Address - Street 1:3553 CASTRO VALLEY BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4400
Practice Address - Country:US
Practice Address - Phone:510-537-1210
Practice Address - Fax:510-537-1082
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist