Provider Demographics
NPI:1417343922
Name:DECANT, ZACHARY (DO)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:DECANT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 LENNON LN STE 152
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2443
Mailing Address - Country:US
Mailing Address - Phone:925-602-7060
Mailing Address - Fax:925-602-7070
Practice Address - Street 1:575 LENNON LN STE 152
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2443
Practice Address - Country:US
Practice Address - Phone:925-602-7060
Practice Address - Fax:925-602-7070
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-10
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT63587390200000X
CA20A172442084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program