Healthcare Provider Details

I. General information

NPI: 1902742588
Provider Name (Legal Business Name): AUDREY GANOTISI-ZAMORA BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20414 N 27TH AVE
PHOENIX AZ
85027-3250
US

IV. Provider business mailing address

2801 E MARCO POLO RD
PHOENIX AZ
85050-3518
US

V. Phone/Fax

Practice location:
  • Phone: 623-263-3966
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: