Healthcare Provider Details

I. General information

NPI: 1326657461
Provider Name (Legal Business Name): JOUVANY JAHAZIEL ZUNIGA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2020
Last Update Date: 07/24/2020
Certification Date: 07/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 W RUBY ST
PASCO WA
99301-3846
US

IV. Provider business mailing address

3105 W RUBY ST
PASCO WA
99301-3846
US

V. Phone/Fax

Practice location:
  • Phone: 509-302-0745
  • Fax:
Mailing address:
  • Phone: 509-302-0745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License NumberMC16021
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: