Provider Demographics
NPI:1497261903
Name:ZANZE, NATHAN ALEX (BCBA)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:ALEX
Last Name:ZANZE
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1319 CALLE AVANZADO
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6351
Mailing Address - Country:US
Mailing Address - Phone:949-272-6146
Mailing Address - Fax:888-847-8864
Practice Address - Street 1:1319 CALLE AVANZADO
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6351
Practice Address - Country:US
Practice Address - Phone:949-272-6146
Practice Address - Fax:888-847-8864
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11341106E00000X
CARBT-16-18490106S00000X
CA1-23-65407103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician