Healthcare Provider Details

I. General information

NPI: 1558197806
Provider Name (Legal Business Name): JOHN CALEB ZOCKOLL CSFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2024
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR # 8630A
NORFOLK VA
23507-1904
US

IV. Provider business mailing address

1669 SPENCE GATE CIR APT 108
VIRGINIA BEACH VA
23456-6190
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-8000
  • Fax:
Mailing address:
  • Phone: 920-245-1237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number0136000747
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: