Ivy, Zaccariah Desmond

Ivy, Zaccariah Desmond is an individual health care provider with primary practice located at 14000 E Arapahoe Rd #300, Centennial CO 80112-4043. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Ivy, Zaccariah Desmond can be contacted via phone (720) 979-0840.

Contact Information

Primary practice address
14000 E Arapahoe Rd #300 Centennial CO 80112-4043
Phone: (720) 979-0840
Fax: (303) 861-4741
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 3256 Colorado

Profile Details

NPI number 1407135205
LBN Legal business name Ivy, Zaccariah Desmond
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 10th, 2011
Last updated Feb 9th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407135205 NPPES
Colorado MEDICAID 11630582

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