Healthcare Provider Details

I. General information

NPI: 1174207245
Provider Name (Legal Business Name): MONIQUE SOPHIA ZIPPERT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 E HIGHLAND AVE STE 205
PHOENIX AZ
85016-4876
US

IV. Provider business mailing address

13400 E SHEA BLVD
SCOTTSDALE AZ
85259-5499
US

V. Phone/Fax

Practice location:
  • Phone: 602-358-8588
  • Fax: 602-688-6991
Mailing address:
  • Phone: 480-301-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9801
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: