Healthcare Provider Details

I. General information

NPI: 1174681829
Provider Name (Legal Business Name): MRS. MARIA ZAMBRANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5603 W SHANGRI LA RD
GLENDALE AZ
85304-3851
US

IV. Provider business mailing address

5603 W SHANGRI LA RD
GLENDALE AZ
85304-3851
US

V. Phone/Fax

Practice location:
  • Phone: 623-979-1150
  • Fax:
Mailing address:
  • Phone: 623-979-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number11355
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: