Healthcare Provider Details

I. General information

NPI: 1891266193
Provider Name (Legal Business Name): ZITA EVILLA RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2018
Last Update Date: 12/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 EL CAMINO REAL
SOUTH SAN FRANCISCO CA
94080-3208
US

IV. Provider business mailing address

167 VALLEYVIEW WAY
SOUTH SAN FRANCISCO CA
94080-5553
US

V. Phone/Fax

Practice location:
  • Phone: 650-742-2324
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number40392
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: