Provider Demographics
NPI:1790217024
Name:ZACHARY-BENNETT, VIRGINIA ANNE (NP)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:ANNE
Last Name:ZACHARY-BENNETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:VIRGINIA
Other - Middle Name:ANNE
Other - Last Name:ZACHARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18800 MAIN ST.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1717
Mailing Address - Country:US
Mailing Address - Phone:714-842-8100
Mailing Address - Fax:714-842-8181
Practice Address - Street 1:18800 MAIN ST.
Practice Address - Street 2:SUITE 103
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1717
Practice Address - Country:US
Practice Address - Phone:714-842-8100
Practice Address - Fax:714-842-8181
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006093363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care