Healthcare Provider Details

I. General information

NPI: 1023926474
Provider Name (Legal Business Name): ZACHARY RAINIER DAVID
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4929 VAN NUYS BLVD SHERMAN OAKS, CA 91403 UNITED STATES
SHERMAN OAK CA
91403
US

IV. Provider business mailing address

17440 BURBANK BLVD APT 201
ENCINO CA
91316-1753
US

V. Phone/Fax

Practice location:
  • Phone: 818-981-7111
  • Fax:
Mailing address:
  • Phone: 818-575-0345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: