Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | A71687 | CA |
NPI | 1114904422 |
---|---|
Provider Name | Dr. Andres Zimmermann |
First Address | Oceanside, CA 92056-4559 |
Second Address | Oceanside, CA 92056-4559 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2005 |
Last Update Date | 21/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A716870 | PPIN (01) | CA |
A71687 | LICENSE (01) | CA |
BZ062259 | DEA (01) | CA |
H50050 | (02) | CA |