Healthcare Provider Details

I. General information

NPI: 1265695571
Provider Name (Legal Business Name): ZACHARY MICHAEL ZWOLAK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HILLMONT AVE
VENTURA CA
93003-1651
US

IV. Provider business mailing address

800 S VICTORIA AVE, L4615 VCHCA - PHYSICIAN SERVICES
VENTURA CA
93009-0003
US

V. Phone/Fax

Practice location:
  • Phone: 805-652-6100
  • Fax: 805-652-3252
Mailing address:
  • Phone: 805-677-5181
  • Fax: 805-677-5304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number20A12298
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number20A12298
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: