Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | A135617 | CA |
NPI | 1477781193 |
---|---|
Provider Name | Zachary Vandegriend |
First Address | Santa Maria, CA 93454-8906 |
Second Address | Santa Maria, CA 93454-8906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2009 |
Last Update Date | 29/11/2016 |