Provider Demographics
NPI:1790569945
Name:ZIENTARA, MALACHI
Entity Type:Individual
Prefix:MR
First Name:MALACHI
Middle Name:
Last Name:ZIENTARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1157
Mailing Address - Street 2:
Mailing Address - City:OAKRIDGE
Mailing Address - State:OR
Mailing Address - Zip Code:97463-1157
Mailing Address - Country:US
Mailing Address - Phone:541-514-7024
Mailing Address - Fax:
Practice Address - Street 1:123 CLIENTS HOME DRIVE
Practice Address - Street 2:
Practice Address - City:OAKRIDGE
Practice Address - State:OR
Practice Address - Zip Code:97463
Practice Address - Country:US
Practice Address - Phone:541-514-7024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care