Healthcare Provider Details

I. General information

NPI: 1649191610
Provider Name (Legal Business Name): ELISA MAKENNA ZANUDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 S ENGLER AVE
YUMA AZ
85365-3225
US

IV. Provider business mailing address

11417 S CARDINAL DR
YUMA AZ
85365-8305
US

V. Phone/Fax

Practice location:
  • Phone: 928-502-8200
  • Fax:
Mailing address:
  • Phone: 928-256-9115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA17130
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: