Individual
MR. IVAN ZACARIAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RD, IBCLC
Contact information
Practice address
3807 N 7TH ST, PHOENIX, AZ 85014-5005
(480) 407-4280
Mailing address
3877 N 7TH ST FL 4, PHOENIX, AZ 85014-5072
(480) 407-4280
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86064802
AZ
174N00000X
Lactation Consultant (Non-RN)
L-152783
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NONE AVAILABLE
—
Enumeration date
01/04/2023
Last updated
05/20/2025
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