Provider Demographics
NPI:1144749011
Name:WILLIS, ZACHARY DELEON
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:DELEON
Last Name:WILLIS
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 1:1881 AIRPORT FWY APT 515
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-4061
Mailing Address - Country:US
Mailing Address - Phone:214-226-7014
Mailing Address - Fax:
Practice Address - Street 1:1881 AIRPORT FWY APT 515
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-4061
Practice Address - Country:US
Practice Address - Phone:214-226-7014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)