Healthcare Provider Details

I. General information

NPI: 1174584510
Provider Name (Legal Business Name): SALVATORE ZUMMO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12305 E LUPINE AVE
SCOTTSDALE AZ
85259-3302
US

IV. Provider business mailing address

12305 E LUPINE AVE
SCOTTSDALE AZ
85259-3302
US

V. Phone/Fax

Practice location:
  • Phone: 602-717-6031
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3071
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: