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General NPI Number Information
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NPI Number | 1659151389
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Entity Type | Organization
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Legal Business Name | ZENKETAMINE
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Dates
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Enumeration Date | 10/02/2023
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Last Update Date | 10/02/2023
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Provider Practice Location Address
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Address Line | 6538 LONETREE BLVD. STE. 100
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City | ROCKLIN
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State | CA
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Zip | 95765-5899
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Country | US
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Telephone | 916-532-3418
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Fax | 916-532-9653
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Provider Business Mailing Address
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Address Line | 6538 LONETREE BLVD. STE. 100
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City | ROCKLIN
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State | CA
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Zip | 95765-5899
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Country | US
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Telephone | 916-532-3418
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | DR. ERWIN VICTOR SALVADOR BOCO
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Credential | MD
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Telephone | 916-844-6617
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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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