Provider Demographics
NPI:1306262811
Name:MALZHAN, ZACHARIAH (CP,COA)
Entity type:Individual
Prefix:
First Name:ZACHARIAH
Middle Name:
Last Name:MALZHAN
Suffix:
Gender:M
Credentials:CP,COA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:842 CALIFORNIA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2902
Mailing Address - Country:US
Mailing Address - Phone:805-541-3800
Mailing Address - Fax:805-541-3818
Practice Address - Street 1:842 CALIFORNIA BLVD
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2902
Practice Address - Country:US
Practice Address - Phone:805-541-3800
Practice Address - Fax:805-541-3818
Is Sole Proprietor?:No
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECP003546224P00000X
DECOA00188222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist