Healthcare Provider Details

I. General information

NPI: 1033550579
Provider Name (Legal Business Name): AJAY ZACHARIAH BS, RVT, RDCS, RDMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2013
Last Update Date: 07/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11714 N CREEK PKWY N STE 100
BOTHELL WA
98011-8250
US

IV. Provider business mailing address

11714 N CREEK PKWY N STE 100
BOTHELL WA
98011-8250
US

V. Phone/Fax

Practice location:
  • Phone: 425-486-8868
  • Fax: 425-486-8976
Mailing address:
  • Phone: 425-486-8868
  • Fax: 425-486-8976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: