1124246921 NPI number — MINESH RAMESH ZAVERI DO

Table of content: COREY BACA RDH (NPI 1205203460)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124246921 NPI number — MINESH RAMESH ZAVERI DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZAVERI
Provider First Name:
MINESH
Provider Middle Name:
RAMESH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1124246921
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401 N 24TH ST STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85008-4645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-844-7246
Provider Business Mailing Address Fax Number:
602-759-7246

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 N 24TH ST STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85008-4645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-844-7246
Provider Business Practice Location Address Fax Number:
602-759-7246
Provider Enumeration Date:
04/24/2007

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: 207LP2900X , with the licence number:  4831 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 380967 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 556315795 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5178834-11 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5201899-11 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: Z236125 . This is a "MEDICARE PTAN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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