Healthcare Provider Details

I. General information

NPI: 1538956339
Provider Name (Legal Business Name): ZACHARY A PALASEK RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 MAGNOLIA AVE
RIVERSIDE CA
92501-4199
US

IV. Provider business mailing address

30951 HANOVER LN APT 3202
MENIFEE CA
92584-6638
US

V. Phone/Fax

Practice location:
  • Phone: 951-512-6786
  • Fax:
Mailing address:
  • Phone: 909-273-4602
  • Fax: 909-273-4602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number95321812
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: