Provider Demographics
NPI:1205570793
Name:ELLIOTT, ZAKARIYYAA A
Entity type:Individual
Prefix:
First Name:ZAKARIYYAA
Middle Name:A
Last Name:ELLIOTT
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 1:3517 FREESTONE LN
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-0532
Mailing Address - Country:US
Mailing Address - Phone:702-413-5662
Mailing Address - Fax:
Practice Address - Street 1:2915 W CHARLESTON BLVD STE 125
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1939
Practice Address - Country:US
Practice Address - Phone:702-413-5662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator