Healthcare Provider Details

I. General information

NPI: 1922907849
Provider Name (Legal Business Name): ZAYDRA HARPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2026
Last Update Date: 11/05/2026
Certification Date: 11/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1449 MONTCLAIR ST
VALLEJO CA
94592-1196
US

IV. Provider business mailing address

1449 MONTCLAIR ST
VALLEJO CA
94592-1196
US

V. Phone/Fax

Practice location:
  • Phone: 585-737-1090
  • Fax:
Mailing address:
  • Phone: 585-737-1090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberINT55363
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: