Healthcare Provider Details

I. General information

NPI: 1730869959
Provider Name (Legal Business Name): ZACHARY MARK BIRD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2023
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 E 1100 N
AMERICAN FORK UT
84003-3226
US

IV. Provider business mailing address

519 W CENTER ST
PLEASANT GROVE UT
84062-2215
US

V. Phone/Fax

Practice location:
  • Phone: 801-310-6880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: