Provider Demographics
NPI:1720793235
Name:ZUIDEMA, SARAH JUNE
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JUNE
Last Name:ZUIDEMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7791 LINDA VISTA RD APT 23
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-5250
Mailing Address - Country:US
Mailing Address - Phone:909-636-4577
Mailing Address - Fax:
Practice Address - Street 1:9055 BALBOA AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1509
Practice Address - Country:US
Practice Address - Phone:619-329-6799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program