Healthcare Provider Details

I. General information

NPI: 1669587762
Provider Name (Legal Business Name): DR. ZORAIDA CAPLLONCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 NORTH HWY 89 BOB STUMP NORTHERN ARIZONA VA MEDICAL CENTER
PRESCOTT AZ
86313
US

IV. Provider business mailing address

800 W FOREST MEADOWS ST APT. 215
FLAGSTAFF AZ
86001-2902
US

V. Phone/Fax

Practice location:
  • Phone: 180-094-9100
  • Fax:
Mailing address:
  • Phone: 928-774-4292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number10922
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: