Provider Demographics
NPI:1134942402
Name:WALDO, ZANIEL ISAIAH
Entity type:Individual
Prefix:
First Name:ZANIEL
Middle Name:ISAIAH
Last Name:WALDO
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 1:2539 PINE BROOK DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95212-2774
Mailing Address - Country:US
Mailing Address - Phone:209-292-9482
Mailing Address - Fax:
Practice Address - Street 1:3120 W MARCH LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-8235
Practice Address - Country:US
Practice Address - Phone:833-227-3454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician