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General NPI Number Information
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NPI Number | 1669587762
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Entity Type | Individual
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Provider Name | DR. ZORAIDA CAPLLONCH
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Gender | Female
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 500 NORTH HWY 89 BOB STUMP NORTHERN ARIZONA VA MEDICAL CENTER
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City | PRESCOTT
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State | AZ
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Zip | 86313
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Country | US
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Telephone | 180-094-9100
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Fax |
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Provider Business Mailing Address
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Address Line | 800 W FOREST MEADOWS ST APT. 215
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-2902
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Country | US
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Telephone | 928-774-4292
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 10922
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License Number State | PR
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