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General NPI Number Information
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NPI Number | 1225816325
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Entity Type | Organization
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Legal Business Name | ZYON HOME CARE PHYSICIAN LLC
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Dates
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Enumeration Date | 09/19/2023
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Last Update Date | 09/19/2023
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Provider Practice Location Address
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Address Line | 7007 E MAIN ST
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City | MESA
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State | AZ
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Zip | 85207-8204
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Country | US
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Telephone | 214-664-2830
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Fax |
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Provider Business Mailing Address
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Address Line | 103 COTTONWOOD ST # 824
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City | MORENCI
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State | AZ
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Zip | 85540-9634
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | PAIDAMOYO WAGONEKA
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Credential |
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Telephone | 214-664-2830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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