Healthcare Provider Details

I. General information

NPI: 1114375490
Provider Name (Legal Business Name): KATHERINE AGUILERA ZAMBRANO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1682 NE PINE ISLAND RD
CAPE CORAL FL
33909-1756
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-424-1600
  • Fax: 239-424-1640
Mailing address:
  • Phone: 239-424-1600
  • Fax: 239-424-1640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number301106
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME152114
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: