Healthcare Provider Details

I. General information

NPI: 1700863768
Provider Name (Legal Business Name): RICHARD ZALER
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36-24-7 RTE 330
OKINAWA CITY OKINAWA
96367
JP

IV. Provider business mailing address

36-24-7 RTE 330
OKINAWA CITY OKINAWA
96367
JP

V. Phone/Fax

Practice location:
  • Phone: 6341266
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW011368L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: