Provider Information for 1407504319
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ZACHARY PHILLIP CUNNINGHAM
Sex: Male
NPI: 1407504319
Last Updated: 2022-03-10
Certification Date: 2022-01-27
Certification Date: 2022-01-27
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1407504319 | ||||||||
| Enumeration Date | 2022-03-10 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2535 W PAMPA AVE MESA, AZ 85202-7848 United States Phone: 773-619-8529 | Fax: | ||||||||
| Primary Practice Address | 2535 W PAMPA AVE MESA, AZ 85202-7848 United States Phone: 773-619-8529 | Fax: | ||||||||
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