Provider Demographics
NPI:1538660170
Name:ZELLER, JEFF (CP BOCPO)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:ZELLER
Suffix:
Gender:M
Credentials:CP BOCPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1844 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1809
Mailing Address - Country:US
Mailing Address - Phone:530-243-4500
Mailing Address - Fax:530-243-4500
Practice Address - Street 1:1844 SOUTH ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1809
Practice Address - Country:US
Practice Address - Phone:530-243-4500
Practice Address - Fax:530-243-4500
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPG0073849001OtherBLUE SHIELD OF CA
CAGFC000180Medicaid