Provider Demographics
NPI:1588375596
Name:MIGLIORE, ZACHARY (PA-C)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:MIGLIORE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 N HAYDEN RD APT 2076
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-1762
Mailing Address - Country:US
Mailing Address - Phone:708-715-9706
Mailing Address - Fax:
Practice Address - Street 1:3330 N 2ND ST STE 401
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2371
Practice Address - Country:US
Practice Address - Phone:602-606-8949
Practice Address - Fax:602-759-7409
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-09
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9974363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty