Healthcare Provider Details

I. General information

NPI: 1679626170
Provider Name (Legal Business Name): ZACOALCO MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 03/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 NILES ST A
BAKERSFIELD CA
93306-4780
US

IV. Provider business mailing address

5901 NILES ST A
BAKERSFIELD CA
93306-4780
US

V. Phone/Fax

Practice location:
  • Phone: 166-136-3723
  • Fax:
Mailing address:
  • Phone: 166-163-6723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG75144
License Number StateCA

VIII. Authorized Official

Name: MR. SAUL DE LA ROSA
Title or Position: PRESIDENT
Credential: PAC
Phone: 323-588-1383