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General NPI Number Information
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NPI Number | 1609683697
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Entity Type | Individual
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Provider Name | AVALON SANTANA ZAKAZAKINA RN
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Gender | Female
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Dates
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Enumeration Date | 12/13/2024
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 454 LIPAN AVENUE
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City | MESCALERO
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State | NM
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Zip | 88340
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Country | US
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Telephone | 575-464-4802
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Fax |
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Provider Business Mailing Address
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Address Line | 82 PIONEER DR
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City | TIMBERON
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State | NM
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Zip | 88350-9678
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Country | US
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Telephone | 575-987-2209
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 76328
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License Number State | NM
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