Provider Demographics
NPI:1992564447
Name:BOOZE, ZACHARY LANDUS (MD)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:LANDUS
Last Name:BOOZE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 SAGEBRUSH LN
Mailing Address - Street 2:
Mailing Address - City:AMERICAN CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:94503-3147
Mailing Address - Country:US
Mailing Address - Phone:707-652-4037
Mailing Address - Fax:
Practice Address - Street 1:220 SAGEBRUSH LN
Practice Address - Street 2:
Practice Address - City:AMERICAN CANYON
Practice Address - State:CA
Practice Address - Zip Code:94503-3147
Practice Address - Country:US
Practice Address - Phone:707-652-4037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program