Healthcare Provider Details

I. General information

NPI: 1467271742
Provider Name (Legal Business Name): TOMBARI SUGAGE ZUA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2024
Last Update Date: 10/04/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 MASON AVE APT 525
DAYTONA BEACH FL
32117-5128
US

IV. Provider business mailing address

1717 MASON AVE APT 525
DAYTONA BEACH FL
32117-5128
US

V. Phone/Fax

Practice location:
  • Phone: 386-307-8129
  • Fax:
Mailing address:
  • Phone: 386-307-8129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: