Provider Demographics
NPI:1952634453
Name:SAMUEL, ZEDA
Entity Type:Individual
Prefix:MR
First Name:ZEDA
Middle Name:
Last Name:SAMUEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-6148
Mailing Address - Country:US
Mailing Address - Phone:530-514-9466
Mailing Address - Fax:
Practice Address - Street 1:107 PARMAC RD
Practice Address - Street 2:SUITE 2
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2298
Practice Address - Country:US
Practice Address - Phone:530-891-2784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)