Healthcare Provider Details

I. General information

NPI: 1588178123
Provider Name (Legal Business Name): ANNA MARCELA ZUNIGA LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2017
Last Update Date: 11/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 CAMINO MARICOPA
RIO RICO AZ
85648-1817
US

IV. Provider business mailing address

76 LONE STAR LN
NOGALES AZ
85621-9019
US

V. Phone/Fax

Practice location:
  • Phone: 520-375-8669
  • Fax:
Mailing address:
  • Phone: 520-980-6914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP036315
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: