Healthcare Provider Details

I. General information

NPI: 1174035638
Provider Name (Legal Business Name): ZACHARIA NJOROGE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 03/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 N CURTIS RD 6TH FLOOR
BOISE ID
83706
US

IV. Provider business mailing address

3340 E GOLDSTONE WAY
MERIDIAN ID
83642
US

V. Phone/Fax

Practice location:
  • Phone: 208-302-3700
  • Fax: 208-302-3755
Mailing address:
  • Phone: 208-302-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-1541
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: