MEDICARE: MR. NIELES CHRISTIAN ZARAGOZA BARRERA

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	225100000X	Physical Therapist	LPT-033440	AZ

General Provider Information

NPI Number	:	1962288449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NIELES CHRISTIAN ZARAGOZA BARRERA

Provider Business Mailing Address
First Line	:	17744 W BUCKHORN TRL
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85387-2255
Country	:	US
Telephone Number	:	480-938-5843
Fax Number	:

Provider Business Practice Location Address
First Line	:	6630 W CACTUS RD STE B112
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85304-1662
Country	:	US
Telephone Number	:	623-469-5811
Fax Number	:

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

Provider Enumeration Date	:	08/31/2023
Last Update Date	:	01/25/2024

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