Healthcare Provider Details

I. General information

NPI: 1861007775
Provider Name (Legal Business Name): ANZHELA ZAKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 09/09/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6316 45TH STREET CT W
TACOMA WA
98466-5626
US

IV. Provider business mailing address

6316 45TH STREET CT W
TACOMA WA
98466-5626
US

V. Phone/Fax

Practice location:
  • Phone: 253-732-0801
  • Fax:
Mailing address:
  • Phone: 253-732-0801
  • Fax: 253-566-4558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License NumberMC6099
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: