=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730933185
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | Z.C. FOR WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2024
-----------------------------------------------------
Last Update Date | 04/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1773 SAN PABLO AVE
-----------------------------------------------------
City | PINOLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94564-2083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-833-7462
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2601 HILLTOP DR
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94806-5783
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ZARINAH CLARK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 510-467-6410
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------