Healthcare Provider Details

I. General information

NPI: 1336105998
Provider Name (Legal Business Name): JAFET EMIRO GONZALEZ-ZAKARCHENCO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 SW LEE ST
NEWPORT OR
97365-3823
US

IV. Provider business mailing address

36 SW NYE ST
NEWPORT OR
97365-3821
US

V. Phone/Fax

Practice location:
  • Phone: 541-574-5960
  • Fax:
Mailing address:
  • Phone: 541-574-5960
  • Fax: 541-265-0601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number9454
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD212113
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: