Healthcare Provider Details

I. General information

NPI: 1174058762
Provider Name (Legal Business Name): MARRIANE ZURBANO NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 06/18/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4579 MAPLE AVE STE 1
LA MESA CA
91941-3154
US

IV. Provider business mailing address

4579 MAPLE AVE STE 1
LA MESA CA
91941-3154
US

V. Phone/Fax

Practice location:
  • Phone: 619-567-2258
  • Fax: 888-628-6680
Mailing address:
  • Phone: 619-567-2258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95006441
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: