MEDICARE: DR. PHILLIP CHARLES ZINNI III DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QS0010X	Sports Medicine (Family Medicine) Physician	20A5756	CA

General Provider Information

NPI Number	:	1366447385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILLIP CHARLES ZINNI III DO

Provider Business Mailing Address
First Line	:	1344 DISC DR STE 272
Second Line	:
City	:	SPARKS
State	:	NV
Zip	:	89436-0684
Country	:	US
Telephone Number	:	209-324-2255
Fax Number	:

Provider Business Practice Location Address
First Line	:	9333 DOUBLE R BLVD STE 100
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89521-2962
Country	:	US
Telephone Number	:	775-636-8900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	08/17/2023

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