Provider Demographics
NPI:1720102601
Name:ZIMMER, BARRY TODD (LAC)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:TODD
Last Name:ZIMMER
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15752 VIA CALANOVA
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4429
Mailing Address - Country:US
Mailing Address - Phone:858-335-4359
Mailing Address - Fax:
Practice Address - Street 1:11777 BERNARDO PLAZA CT
Practice Address - Street 2:SUITE 107
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2405
Practice Address - Country:US
Practice Address - Phone:858-487-8246
Practice Address - Fax:858-487-8246
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 9358171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist