Provider Demographics
NPI:1679221717
Name:ANTHONY ZAMUDIO PHD
Entity Type:Organization
Organization Name:ANTHONY ZAMUDIO PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMUDIO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:818-546-8885
Mailing Address - Street 1:3786 LA CRESCENTA AVE STE 101-102
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1055
Mailing Address - Country:US
Mailing Address - Phone:818-546-8885
Mailing Address - Fax:818-672-1961
Practice Address - Street 1:3786 LA CRESCENTA AVE STE 101-102
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1055
Practice Address - Country:US
Practice Address - Phone:818-546-8885
Practice Address - Fax:818-672-1961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty