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General NPI Number Information
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NPI Number | 1861158552
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Entity Type | Individual
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Provider Name | ANDREA ESTEFANIA LUNA ZAMBRANO
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Gender | Female
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Dates
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Enumeration Date | 11/17/2021
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Last Update Date | 11/17/2021
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Provider Practice Location Address
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Address Line | 1107 COVENTRY WAY APT D
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City | MARYSVILLE
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State | OH
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Zip | 43040-9077
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Country | US
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Telephone | 786-450-9568
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Fax |
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Provider Business Mailing Address
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Address Line | 1107 COVENTRY WAY APT D
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City | MARYSVILLE
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State | OH
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Zip | 43040-9077
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Country | US
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Telephone | 786-450-9568
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 21-624
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License Number State | WI
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