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NPI Code Detail

MEDICARE: NICOL ALEXANDR ZOUBKOV

MEDICARE: NICOL ALEXANDR ZOUBKOV
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1417653890
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOL ALEXANDR ZOUBKOV
Provider Business Mailing Address
First Line : 5850 GRANITE PKWY STE 600
Second Line :
City : PLANO
State : TX
Zip : 75024-6753
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3315 S 23RD ST STE 102
Second Line :
City : TACOMA
State : WA
Zip : 98405-1615
Country : US
Telephone Number : 253-345-5720
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2023
Last Update Date : 02/06/2023

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Directions to “ NICOL ALEXANDR ZOUBKOV ” Practice Location

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