MEDICARE: BRITA ZIZUMBO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253J00000X	Foster Care Agency	1834	UT

General Provider Information

NPI Number	:	1730515198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITA ZIZUMBO

Provider Business Mailing Address
First Line	:	619 N 500 W
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84601-1547
Country	:	US
Telephone Number	:	801-375-4240
Fax Number	:	801-375-4241

Provider Business Practice Location Address
First Line	:	41 W 700 S
Second Line	:
City	:	EPHRAIM
State	:	UT
Zip	:	84627-1524
Country	:	US
Telephone Number	:	435-283-4690
Fax Number	:	435-283-4389

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2013
Last Update Date	:	09/17/2013

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Directions to “ BRITA ZIZUMBO ” Practice Location

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