Provider Demographics
NPI:1881112266
Name:ZIMMERMANN, RUPA PURI (PHD)
Entity type:Individual
Prefix:DR
First Name:RUPA
Middle Name:PURI
Last Name:ZIMMERMANN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1399 YGNACIO VALLEY RD STE 3
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2868
Mailing Address - Country:US
Mailing Address - Phone:925-378-3944
Mailing Address - Fax:
Practice Address - Street 1:1399 YGNACIO VALLEY RD STE 3
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2868
Practice Address - Country:US
Practice Address - Phone:925-378-3944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05427103TC0700X
CAPSY29209103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical