Healthcare Provider Details

I. General information

NPI: 1811358740
Provider Name (Legal Business Name): PETER ZACCARIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: HUNTER CONSTRUCTION

II. Dates (important events)

Enumeration Date: 03/20/2016
Last Update Date: 03/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6555 CACHE DR
COLORADO SPRINGS CO
80923-3430
US

IV. Provider business mailing address

6555 CACHE DR
COLORADO SPRINGS CO
80923-3430
US

V. Phone/Fax

Practice location:
  • Phone: 719-330-2833
  • Fax:
Mailing address:
  • Phone: 719-330-2833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number922587701
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: