Provider Demographics
NPI:1568815439
Name:ZAMANI, CHELZE
Entity Type:Individual
Prefix:
First Name:CHELZE
Middle Name:
Last Name:ZAMANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 COLLARD WAY
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-8213
Mailing Address - Country:US
Mailing Address - Phone:714-504-7732
Mailing Address - Fax:
Practice Address - Street 1:421 COLLARD WAY
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-8213
Practice Address - Country:US
Practice Address - Phone:714-504-7732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1568815439Medicaid