Healthcare Provider Details

I. General information

NPI: 1750754834
Provider Name (Legal Business Name): THERESA ZAMBINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2015
Last Update Date: 11/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 NE 50TH ST
OKLAHOMA CITY OK
73141-9118
US

IV. Provider business mailing address

769 SW 19TH ST APT. 13102
MOORE OK
73160-3046
US

V. Phone/Fax

Practice location:
  • Phone: 405-605-6111
  • Fax: 405-427-0351
Mailing address:
  • Phone: 330-219-2924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: