Healthcare Provider Details

I. General information

NPI: 1063535748
Provider Name (Legal Business Name): THOMAS ZUREK RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 ROSECRANS ST
SAN DIEGO CA
92110-3115
US

IV. Provider business mailing address

9006 AKARD ST
SPRING VALLEY CA
91977-5815
US

V. Phone/Fax

Practice location:
  • Phone: 619-293-4730
  • Fax: 619-296-2368
Mailing address:
  • Phone: 619-479-5670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number545728
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: