Provider Demographics
NPI:1477781193
Name:VANDEGRIEND, ZACHARY (MD)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:VANDEGRIEND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 S PALISADE DR STE 206
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-8906
Mailing Address - Country:US
Mailing Address - Phone:805-614-9250
Mailing Address - Fax:805-614-9260
Practice Address - Street 1:116 S PALISADE DR STE 206
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8906
Practice Address - Country:US
Practice Address - Phone:805-614-9250
Practice Address - Fax:805-614-9260
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA135617207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery