Healthcare Provider Details

I. General information

NPI: 1629095567
Provider Name (Legal Business Name): KAY ZAGARIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 WOODROW AVE SUITE B-10
MODESTO CA
95350-1288
US

IV. Provider business mailing address

830 SCENIC DR SUITE B
MODESTO CA
95350-6131
US

V. Phone/Fax

Practice location:
  • Phone: 209-558-5312
  • Fax:
Mailing address:
  • Phone: 209-558-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP12514
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: