Provider Demographics
NPI:1659151389
Name:ZENKETAMINE
Entity Type:Organization
Organization Name:ZENKETAMINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ERWIN VICTOR
Authorized Official - Middle Name:SALVADOR
Authorized Official - Last Name:BOCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-844-6617
Mailing Address - Street 1:6538 LONETREE BLVD. STE. 100
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-5899
Mailing Address - Country:US
Mailing Address - Phone:916-532-3418
Mailing Address - Fax:
Practice Address - Street 1:6538 LONETREE BLVD. STE. 100
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-5899
Practice Address - Country:US
Practice Address - Phone:916-532-3418
Practice Address - Fax:916-532-9653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty