Provider Demographics
NPI:1922416023
Name:IDRO, ZEKHARIAH INYASIO (PA-C)
Entity Type:Individual
Prefix:
First Name:ZEKHARIAH
Middle Name:INYASIO
Last Name:IDRO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82013 DR CARREON BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-4832
Mailing Address - Country:US
Mailing Address - Phone:760-775-9500
Mailing Address - Fax:760-775-9500
Practice Address - Street 1:82013 DR CARREON BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-4832
Practice Address - Country:US
Practice Address - Phone:760-775-9500
Practice Address - Fax:760-775-9500
Is Sole Proprietor?:No
Enumeration Date:2014-08-01
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52215363A00000X
NE1842363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical