Healthcare Provider Details

I. General information

NPI: 1043985229
Provider Name (Legal Business Name): MELANIE I. ZUK-MOYA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 DIVISADERO ST
SAN FRANCISCO CA
94143-3010
US

IV. Provider business mailing address

1420 CHESTNUT ST UNIT A
SAN FRANCISCO CA
94123-3116
US

V. Phone/Fax

Practice location:
  • Phone: 646-770-6621
  • Fax:
Mailing address:
  • Phone: 646-770-6621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number6666
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: