Healthcare Provider Details

I. General information

NPI: 1417156001
Provider Name (Legal Business Name): TZONKA HRISTOV MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 BIMINI LN
RIVIERA BEACH FL
33404-2704
US

IV. Provider business mailing address

1030 BIMINI LN
RIVIERA BEACH FL
33404-2704
US

V. Phone/Fax

Practice location:
  • Phone: 561-840-0494
  • Fax: 561-840-0494
Mailing address:
  • Phone: 561-840-0494
  • Fax: 561-840-0494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME 81363
License Number StateFL

VIII. Authorized Official

Name: TZONKA HRISTOV
Title or Position: PRESIDENT
Credential: M.D.
Phone: 561-840-0494