Healthcare Provider Details

I. General information

NPI: 1730550146
Provider Name (Legal Business Name): JENNIFER ZAZUETA CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2015
Last Update Date: 09/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4126 E NIGHTHAWK WAY
PHOENIX AZ
85048
US

IV. Provider business mailing address

P.O. BOX 21449
MESA AZ
85277
US

V. Phone/Fax

Practice location:
  • Phone: 480-720-8602
  • Fax: 480-365-0507
Mailing address:
  • Phone: 480-221-4815
  • Fax: 480-985-6247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number246ZC0007X
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: