Healthcare Provider Details

I. General information

NPI: 1194571240
Provider Name (Legal Business Name): PHILIP ANDREW ZUMARAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

973 MICA DR STE 201
CARSON CITY NV
89705-7258
US

IV. Provider business mailing address

5310 KIETZKE LN STE 104
RENO NV
89511-2043
US

V. Phone/Fax

Practice location:
  • Phone: 775-348-8800
  • Fax: 833-687-1419
Mailing address:
  • Phone: 775-348-8800
  • Fax: 833-687-1419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: