Healthcare Provider Details

I. General information

NPI: 1669132296
Provider Name (Legal Business Name): ZAKIAH J COWAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2021
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12437 LEWIS ST STE 100
GARDEN GROVE CA
92840-4651
US

IV. Provider business mailing address

8600 WEST LN SPC 174
STOCKTON CA
95210-2216
US

V. Phone/Fax

Practice location:
  • Phone: 714-202-0118
  • Fax:
Mailing address:
  • Phone: 209-373-0766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: