MEDICARE: ZEGARRA HOSPITAL AND NURSING HOME SERVICES PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1518580869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZEGARRA HOSPITAL AND NURSING HOME SERVICES PLLC

Provider Business Mailing Address
First Line	:	PO BOX 20247
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86439-0247
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2182 HWAY 95
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-6044
Country	:	US
Telephone Number	:	928-758-6420
Fax Number	:

Authorized Official
Title or Position	:	SOLE OWNER
Name	:	GUILLERMO ZEGARRA
Credential	:	MD
Telephone Number	:	928-758-6420

Provider Enumeration Date	:	05/21/2020
Last Update Date	:	05/21/2020

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