Provider Demographics
NPI:1801970165
Name:ZIMBROFF AND MOSKOVITZ
Entity type:Organization
Organization Name:ZIMBROFF AND MOSKOVITZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:ZIMBROFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:909-981-4242
Mailing Address - Street 1:1317 W FOOTHILL BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3676
Mailing Address - Country:US
Mailing Address - Phone:909-981-4242
Mailing Address - Fax:
Practice Address - Street 1:1317 W FOOTHILL BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3676
Practice Address - Country:US
Practice Address - Phone:909-981-4242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAYYY49990YOtherBLUE SHIELD