Healthcare Provider Details

I. General information

NPI: 1679293575
Provider Name (Legal Business Name): DIANA ZUNIGA11
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 OLD TURNPIKE RD STE 307
NANUET NY
10954-2530
US

IV. Provider business mailing address

20 OLD TURNPIKE RD STE 307
NANUET NY
10954-2530
US

V. Phone/Fax

Practice location:
  • Phone: 845-624-0260
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number851105
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: