1770871428 NPI number — MR. ZACHARY G. ZORROZUA LICSW

Table of content: MR. ZACHARY G. ZORROZUA LICSW (NPI 1770871428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770871428 NPI number — MR. ZACHARY G. ZORROZUA LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZORROZUA
Provider First Name:
ZACHARY
Provider Middle Name:
G.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770871428
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1124 W. RIVERSIDE AVE
Provider Second Line Business Mailing Address:
LL2
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99201-1109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-953-5696
Provider Business Mailing Address Fax Number:
509-455-8903

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1124 W. RIVERSIDE AVE
Provider Second Line Business Practice Location Address:
LL2
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-953-5696
Provider Business Practice Location Address Fax Number:
509-455-8903
Provider Enumeration Date:
07/15/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LW 60185202 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2039680 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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