Healthcare Provider Details

I. General information

NPI: 1790158772
Provider Name (Legal Business Name): IVONNETT ARCIA ZAMORA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2015
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8415 SW 24TH ST SUITE 205
MIAMI FL
33155
US

IV. Provider business mailing address

8415 SW 24TH ST SUITE 205
MIAMI FL
33155
US

V. Phone/Fax

Practice location:
  • Phone: 305-262-6868
  • Fax: 305-262-6867
Mailing address:
  • Phone: 305-262-6868
  • Fax: 305-262-6867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA26134
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: