Healthcare Provider Details

I. General information

NPI: 1487537569
Provider Name (Legal Business Name): ADRIAN ZATARAIN PT ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36953 COOK ST
PALM DESERT CA
92211-6083
US

IV. Provider business mailing address

36953 COOK ST
PALM DESERT CA
92211-6083
US

V. Phone/Fax

Practice location:
  • Phone: 760-797-7540
  • Fax:
Mailing address:
  • Phone: 760-797-7540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number54244
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: