Provider Demographics
NPI:1992952311
Name:ZACHARIA, CORY ALEXANDER
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:ALEXANDER
Last Name:ZACHARIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 E OLDFIELD ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-1728
Mailing Address - Country:US
Mailing Address - Phone:661-674-5016
Mailing Address - Fax:
Practice Address - Street 1:1609 E PALMDALE BLVD
Practice Address - Street 2:STEG
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4881
Practice Address - Country:US
Practice Address - Phone:661-947-1595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator