Healthcare Provider Details

I. General information

NPI: 1992909121
Provider Name (Legal Business Name): RANDALL D ZRUBEK RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W THOMAS RD
PHOENIX AZ
85013-4409
US

IV. Provider business mailing address

780 E 1ST ST
MESA AZ
85203-8714
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-3154
  • Fax:
Mailing address:
  • Phone: 480-649-4079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number7380
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: