Provider Demographics
NPI:1578633475
Name:ZIMMER, CHARLES E (PHD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:ZIMMER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-6806
Mailing Address - Country:US
Mailing Address - Phone:805-737-7715
Mailing Address - Fax:
Practice Address - Street 1:401 E CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-6806
Practice Address - Country:US
Practice Address - Phone:805-737-7715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 8967103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist