Healthcare Provider Details

I. General information

NPI: 1316443039
Provider Name (Legal Business Name): JENNIFER RAI L ZAMBALES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 SOUTHERN BLVD
KETTERING OH
45429-1221
US

IV. Provider business mailing address

3131 NEWMARK DR STE 220
MIAMISBURG OH
45342-5400
US

V. Phone/Fax

Practice location:
  • Phone: 937-395-8839
  • Fax: 937-395-8387
Mailing address:
  • Phone:
  • Fax: 937-395-8387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35141173
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberCDR.0006535
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: