Provider Demographics
NPI:1285741587
Name:ZAZA, DINA I III (MD)
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:I
Last Name:ZAZA
Suffix:III
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 FM 1960 RD W
Mailing Address - Street 2:SUITE #230
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-3000
Mailing Address - Country:US
Mailing Address - Phone:877-749-7428
Mailing Address - Fax:281-724-3100
Practice Address - Street 1:4202 N 20TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-5101
Practice Address - Country:US
Practice Address - Phone:602-264-3824
Practice Address - Fax:602-279-6234
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ358382081P2900X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI31809Medicare UPIN