Healthcare Provider Details

I. General information

NPI: 1548875347
Provider Name (Legal Business Name): REBECCA ZANZERKIA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 ARIZONA AVE
SANTA MONICA CA
90404-1337
US

IV. Provider business mailing address

3 SHADOWBROOK DR
NASHUA NH
03062-4543
US

V. Phone/Fax

Practice location:
  • Phone: 310-582-7450
  • Fax: 310-582-7495
Mailing address:
  • Phone: 603-521-0716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number025612
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number025612
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number025612
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number61428
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: