Provider Demographics
NPI:1023583580
Name:TEIXEIRA, ZACHARY SEBASTIAN (MS, RN, CPNP-PC)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:SEBASTIAN
Last Name:TEIXEIRA
Suffix:
Gender:M
Credentials:MS, RN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37930 PALMER DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-5018
Mailing Address - Country:US
Mailing Address - Phone:510-304-7667
Mailing Address - Fax:
Practice Address - Street 1:4133B ARGYLE CT
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-4917
Practice Address - Country:US
Practice Address - Phone:510-304-7667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009791363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics