Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | COA00188 | DE |
N | 222Z00000X | Podiatrist | COA00188 | DE |
Y | 224P00000X | Prosthetist | CP003546 | DE |
NPI | 1306262811 |
---|---|
Provider Name | Zachariah Malzhan |
First Address | San Luis Obispo, CA 93401-2902 |
Second Address | San Luis Obispo, CA 93401-2902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2014 |
Last Update Date | 07/03/2014 |