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General NPI Number Information
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NPI Number | 1255394938
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Entity Type | Individual
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Provider Name | THERESA GERTRUDE ZOGAKIS MD
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Gender | Female
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Dates
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Enumeration Date | 04/11/2006
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Last Update Date | 01/24/2023
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Provider Practice Location Address
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Address Line | 414 G ST STE 120
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City | MARYSVILLE
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State | CA
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Zip | 95901-5670
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Country | US
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Telephone | 530-749-4304
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Fax |
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Provider Business Mailing Address
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Address Line | 2351 SUNSET BLVD STE 170-158
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City | ROCKLIN
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State | CA
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Zip | 95765-4338
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Country | US
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Telephone | 916-747-5448
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A82403
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | M2510
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License Number State | TX
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