Healthcare Provider Details

I. General information

NPI: 1306684634
Provider Name (Legal Business Name): NUBIA SELENA ZAMBRANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2024
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 N BRAND BLVD STE 100
GLENDALE CA
91203-3240
US

IV. Provider business mailing address

611 N BRAND BLVD STE 100
GLENDALE CA
91203-3240
US

V. Phone/Fax

Practice location:
  • Phone: 747-286-2600
  • Fax:
Mailing address:
  • Phone: 747-286-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number131434
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: