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General NPI Number Information
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NPI Number | 1902800717
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Entity Type | Individual
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Provider Name | RALPH T ZYCH PAC
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Gender | Male
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 01/03/2011
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Provider Practice Location Address
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Address Line | 6801 JEFFERSON ST NE SUITE 350
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4379
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Country | US
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Telephone | 505-242-1711
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Fax | 505-242-0291
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Provider Business Mailing Address
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Address Line | 6801 JEFFERSON ST NE SUITE 350
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4379
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Country | US
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Telephone | 505-242-1711
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Fax | 505-242-0291
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 81PA014
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License Number State | NM
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