Healthcare Provider Details

I. General information

NPI: 1245712801
Provider Name (Legal Business Name): VICKI ELIANA ZUCKER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 06/27/2025
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOAG DR BLDG 31
NEWPORT BEACH CA
92663-4162
US

IV. Provider business mailing address

PO BOX 26039
SANTA ANA CA
92799-6039
US

V. Phone/Fax

Practice location:
  • Phone: 949-650-3350
  • Fax: 949-764-1493
Mailing address:
  • Phone: 949-650-3350
  • Fax: 949-764-1493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA63155
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: