Provider Demographics
NPI:1588433726
Name:DESERT ZEN HEALTHCARE
Entity type:Organization
Organization Name:DESERT ZEN HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN ASSIST/BILLING
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-247-9277
Mailing Address - Street 1:11611 S FOOTHILLS BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85367-5845
Mailing Address - Country:US
Mailing Address - Phone:928-247-9277
Mailing Address - Fax:
Practice Address - Street 1:11611 S FOOTHILLS BLVD STE F
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85367-5845
Practice Address - Country:US
Practice Address - Phone:282-479-2779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-29
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ159894Medicaid