Provider Demographics
NPI:1700160470
Name:ZEIDERS ENTERPRISES
Entity Type:Organization
Organization Name:ZEIDERS ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:ERKENBECK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:619-556-8817
Mailing Address - Street 1:3803 CAMINO LINDO
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-1917
Mailing Address - Country:US
Mailing Address - Phone:858-678-0449
Mailing Address - Fax:619-553-7506
Practice Address - Street 1:140 SYLVESTER RD BLDG 212
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-3521
Practice Address - Country:US
Practice Address - Phone:619-553-0367
Practice Address - Fax:619-553-7506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34604251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health