Healthcare Provider Details

I. General information

NPI: 1881192623
Provider Name (Legal Business Name): PAUL ZINN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2018
Last Update Date: 01/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 WILDCAT DR
BRAWLEY CA
92227-9654
US

IV. Provider business mailing address

214 QUAIL RUN DR
EL CENTRO CA
92243-8431
US

V. Phone/Fax

Practice location:
  • Phone: 760-351-1650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number52775
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: