Healthcare Provider Details

I. General information

NPI: 1790915270
Provider Name (Legal Business Name): ZELPHA MARIE FLORA CST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2009
Last Update Date: 07/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 SOUTHERN BLVD
KETTERING OH
45429
US

IV. Provider business mailing address

301 WEST FIRST STREET, SUITE 300, THIRD FLOOR DAYTON VITREO-RETINAL ASSOCIATES, INC.
DAYTON OH
45402-3033
US

V. Phone/Fax

Practice location:
  • Phone: 937-298-4331
  • Fax:
Mailing address:
  • Phone: 937-228-5015
  • Fax: 937-228-5971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License NumberCERTIFICATE#31601
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: