Provider Demographics
NPI:1174960090
Name:THE HEALTHY TEEN PROJECT, INC.
Entity type:Organization
Organization Name:THE HEALTHY TEEN PROJECT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUMARRAGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-946-1972
Mailing Address - Street 1:919 FREMONT AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-6024
Mailing Address - Country:US
Mailing Address - Phone:650-941-2300
Mailing Address - Fax:
Practice Address - Street 1:919 FREMONT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-6024
Practice Address - Country:US
Practice Address - Phone:650-941-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-01
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83076261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health