Healthcare Provider Details

I. General information

NPI: 1164497046
Provider Name (Legal Business Name): MARY M. ZHU M.D, PHD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CALIFORNIA DR
VACAVILLE CA
95687
US

IV. Provider business mailing address

1600 CALIFORNIA DR
VACAVILLE CA
95687
US

V. Phone/Fax

Practice location:
  • Phone: 707-420-0110
  • Fax:
Mailing address:
  • Phone: 707-420-0110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA52298
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: