Provider Demographics
NPI:1609085331
Name:ALEXANDER ZUCKERBRAUN PHD. MD
Entity Type:Organization
Organization Name:ALEXANDER ZUCKERBRAUN PHD. MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUCKERBRAUN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD MD
Authorized Official - Phone:805-922-4541
Mailing Address - Street 1:801 E CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4607
Mailing Address - Country:US
Mailing Address - Phone:805-922-4541
Mailing Address - Fax:
Practice Address - Street 1:801 E CHAPEL ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4607
Practice Address - Country:US
Practice Address - Phone:805-922-4541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC21327261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C213270Medicaid
CAA31907Medicare UPIN
CAC21327Medicare ID - Type UnspecifiedMEDICARE