Provider Demographics
NPI:1548875347
Name:ZANZERKIA, REBECCA (PA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:ZANZERKIA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SHADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-4543
Mailing Address - Country:US
Mailing Address - Phone:603-521-0716
Mailing Address - Fax:
Practice Address - Street 1:2125 ARIZONA AVE
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1337
Practice Address - Country:US
Practice Address - Phone:310-582-7450
Practice Address - Fax:310-582-7495
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025612363AM0700X, 363A00000X, 363AS0400X
CA61428363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical