Healthcare Provider Details

I. General information

NPI: 1710147467
Provider Name (Legal Business Name): FAINA ZOLOTARYOV CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 FANNIN ST SUITE 2300
HOUSTON TX
77054-2934
US

IV. Provider business mailing address

9206 BINTLIFF DR
HOUSTON TX
77074-7318
US

V. Phone/Fax

Practice location:
  • Phone: 713-790-1349
  • Fax: 713-790-0028
Mailing address:
  • Phone: 713-829-5834
  • Fax: 713-790-0028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number722767
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number78738
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: