Basic Information
| Provider Information | |||||||||
| NPI: | 1790332245 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZIMBARDO | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | CLAYTON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3300 PEARL CIR | ||||||||
| Address2: | |||||||||
| City: | SIMI VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930631540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056300816 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2805 5TH ST | ||||||||
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| City: | RAPID CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577016003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6057555700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2019 | ||||||||
| LastUpdateDate: | 09/14/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 1308 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.