Provider Demographics
NPI:1659011518
Name:OJINAGA, ZACK (RCEP)
Entity Type:Individual
Prefix:
First Name:ZACK
Middle Name:
Last Name:OJINAGA
Suffix:
Gender:M
Credentials:RCEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3408 TRIO LN
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2071
Mailing Address - Country:US
Mailing Address - Phone:559-920-0119
Mailing Address - Fax:
Practice Address - Street 1:10471 GRANT LINE RD STE 170
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-5073
Practice Address - Country:US
Practice Address - Phone:916-883-3366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1066004224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise PhysiologistGroup - Single Specialty