Provider Demographics
NPI:1275227217
Name:ZAKI, SUSAN (RPA (CBRPA), RT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:ZAKI
Suffix:
Gender:F
Credentials:RPA (CBRPA), RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 TRIADOR ST UNIT 103
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-7996
Mailing Address - Country:US
Mailing Address - Phone:626-826-3010
Mailing Address - Fax:
Practice Address - Street 1:801 S MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-3410
Practice Address - Country:US
Practice Address - Phone:951-238-6071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA07CA1326243U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant