Healthcare Provider Details

I. General information

NPI: 1265084883
Provider Name (Legal Business Name): BRIANNA ZUNIGA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2019
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 SAINT MICHAELS DR
SANTA FE NM
87505-7601
US

IV. Provider business mailing address

1500 N RENAISSANCE BLVD NE
ALBUQUERQUE NM
87107-7002
US

V. Phone/Fax

Practice location:
  • Phone: 505-992-0233
  • Fax: 505-992-0609
Mailing address:
  • Phone: 505-266-5565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number61487
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: