Healthcare Provider Details

I. General information

NPI: 1356823231
Provider Name (Legal Business Name): RACHAEL HANNAH ZOMBORY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12650 E BRIARWOOD AVE UNIT 207
CENTENNIAL CO
80112-6792
US

IV. Provider business mailing address

3935 ESTATES CIR
LARKSPUR CO
80118-5627
US

V. Phone/Fax

Practice location:
  • Phone: 720-470-0578
  • Fax:
Mailing address:
  • Phone: 352-870-4601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: