Healthcare Provider Details

I. General information

NPI: 1174457295
Provider Name (Legal Business Name): NORCILIEN ZIDOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3807 S MERCY DR
SPOKANE VALLEY WA
99206-9517
US

IV. Provider business mailing address

14814 N HEDIN RD
NINE MILE FALLS WA
99026-9613
US

V. Phone/Fax

Practice location:
  • Phone: 914-615-8806
  • Fax:
Mailing address:
  • Phone: 914-615-8806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number12737
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: