Provider Demographics
NPI:1811358740
Name:ZACCARIA, PETER
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:ZACCARIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:HUNTER
Other - Middle Name:
Other - Last Name:CONSTRUCTION
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6555 CACHE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-3430
Mailing Address - Country:US
Mailing Address - Phone:719-330-2833
Mailing Address - Fax:
Practice Address - Street 1:6555 CACHE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-3430
Practice Address - Country:US
Practice Address - Phone:719-330-2833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-20
Last Update Date:2016-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO922587701171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications