Healthcare Provider Details

I. General information

NPI: 1306861612
Provider Name (Legal Business Name): DELMA FARIA ZARDO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. DELMA GOULART FARIA

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/14/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 STANDIFORD AVE STE 4
MODESTO CA
95350-0977
US

IV. Provider business mailing address

2421 KISKA DR
MODESTO CA
95355-7913
US

V. Phone/Fax

Practice location:
  • Phone: 209-524-7870
  • Fax: 209-524-7985
Mailing address:
  • Phone: 209-605-0442
  • Fax: 209-524-7985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT12678T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: