Basic Information
| Provider Information | |||||||||
| NPI: | 1730840372 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ZAZ MED INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6307 SWANSON ST | ||||||||
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| City: | WINDERMERE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347864118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7873764194 | ||||||||
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| Practice Location | |||||||||
| Address1: | 17410 HIGHWAY 50 STE 110 | ||||||||
| Address2: | |||||||||
| City: | CLERMONT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347118188 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7873764194 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2022 | ||||||||
| LastUpdateDate: | 01/05/2022 | ||||||||
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| AuthorizedOfficialLastName: | SOTO | ||||||||
| AuthorizedOfficialFirstName: | ZY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7873764194 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 01/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.