Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | CA22221 | CA |
Y | 213ER0200X | Radiology | CA22221 | CA |
NPI | 1700807823 |
---|---|
Provider Name | Dr. Pete Zavacki |
First Address | Campbell, CA 95008-2575 |
Second Address | Campbell, CA 95008-2575 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2006 |
Last Update Date | 13/02/2008 |