Healthcare Provider Details

I. General information

NPI: 1255394938
Provider Name (Legal Business Name): THERESA GERTRUDE ZOGAKIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 G ST STE 120
MARYSVILLE CA
95901-5670
US

IV. Provider business mailing address

2351 SUNSET BLVD STE 170-158
ROCKLIN CA
95765-4338
US

V. Phone/Fax

Practice location:
  • Phone: 530-749-4304
  • Fax:
Mailing address:
  • Phone: 916-747-5448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA82403
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberM2510
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: