Healthcare Provider Details

I. General information

NPI: 1720688179
Provider Name (Legal Business Name): WRANGA B ZADRAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 10/27/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W BURBANK BLVD
BURBANK CA
91505-2347
US

IV. Provider business mailing address

3417 TREVI CT
STOCKTON CA
95212-2742
US

V. Phone/Fax

Practice location:
  • Phone: 818-856-9535
  • Fax:
Mailing address:
  • Phone: 209-817-4585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA58250
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: