Healthcare Provider Details

I. General information

NPI: 1609824655
Provider Name (Legal Business Name): GARIMA PRASAD ZUCKER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/20/2022
Certification Date: 05/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 E HURST BLVD
HURST TX
76053
US

IV. Provider business mailing address

1859 BROKEN BEND DR
WESTLAKE TX
76262-8205
US

V. Phone/Fax

Practice location:
  • Phone: 817-907-2458
  • Fax: 817-481-6828
Mailing address:
  • Phone: 817-907-2458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL3440
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: