Healthcare Provider Details

I. General information

NPI: 1124266135
Provider Name (Legal Business Name): JAN CARLO ZEGARRA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2009
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 ICON
FOOTHILL RANCH CA
92610-3000
US

IV. Provider business mailing address

74 ICON
FOOTHILL RANCH CA
92610-3000
US

V. Phone/Fax

Practice location:
  • Phone: 787-234-8371
  • Fax: 949-271-4671
Mailing address:
  • Phone: 949-390-9209
  • Fax: 949-271-4671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number32913
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: