Provider Demographics
NPI:1083901003
Name:ZACARIAS, KANDACE SUZANNE
Entity Type:Individual
Prefix:
First Name:KANDACE
Middle Name:SUZANNE
Last Name:ZACARIAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 E EARLL DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2634
Mailing Address - Country:US
Mailing Address - Phone:575-742-2620
Mailing Address - Fax:
Practice Address - Street 1:1110 E HIGH ST
Practice Address - Street 2:
Practice Address - City:TUCUMCARI
Practice Address - State:NM
Practice Address - Zip Code:88401-2510
Practice Address - Country:US
Practice Address - Phone:575-461-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator