Healthcare Provider Details

I. General information

NPI: 1649223942
Provider Name (Legal Business Name): AARON C ZALE IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W MARQUITA
SAN CLEMENTE CA
92672-4728
US

IV. Provider business mailing address

101 WEST MARQUITA AVE APT 21
SAN CLEMENTE CA
92672
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-0115
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number1710I1002X
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: