Basic Information
Provider Information
NPI: 1346990801
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ARAGON
FirstName: ZACHARY
MiddleName: FERRARI
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6440 CRESCENT WAY APT 201
Address2:  
City: NORFOLK
State: VA
PostalCode: 235131423
CountryCode: US
TelephoneNumber: 7578176918
FaxNumber:  
Practice Location
Address1: 293 INDEPENDENCE BLVD STE 400
Address2:  
City: VIRGINIA BEACH
State: VA
PostalCode: 234625461
CountryCode: US
TelephoneNumber: 7574903009
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/28/2022
LastUpdateDate: 03/28/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/28/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106S00000X22-209372VAN    
106S00000XRBT-22-209372VAY    

No ID Information.


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