Provider Demographics
NPI:1518308592
Name:ZAZA REHABMD LLC
Entity Type:Organization
Organization Name:ZAZA REHABMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-415-5259
Mailing Address - Street 1:PO BOX 7019
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78683-7019
Mailing Address - Country:US
Mailing Address - Phone:480-415-5259
Mailing Address - Fax:
Practice Address - Street 1:4202 N 20TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-5101
Practice Address - Country:US
Practice Address - Phone:602-264-3824
Practice Address - Fax:602-279-6234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty