Healthcare Provider Details

I. General information

NPI: 1659879294
Provider Name (Legal Business Name): COLLIN ANTHONY ZADRA BA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2018
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1926 VIA CENTRE DRIVE SUITE B
VISTA CA
92081
US

IV. Provider business mailing address

1926 VIA CENTRE DRIVE SUITE B
VISTA CA
92081
US

V. Phone/Fax

Practice location:
  • Phone: 760-294-1206
  • Fax:
Mailing address:
  • Phone: 760-294-1206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: