MEDICARE: DR. FREDDY ZAMBRANO D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	59080	CA

General Provider Information

NPI Number	:	1407172356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDDY ZAMBRANO D.D.S.

Provider Business Mailing Address
First Line	:	1666 MEDICAL CENTER DR STE 3
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92411-1257
Country	:	US
Telephone Number	:	909-881-5007
Fax Number	:	951-689-4800

Provider Business Practice Location Address
First Line	:	1666 MEDICAL CENTER DR STE 3
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92411-1257
Country	:	US
Telephone Number	:	909-881-5007
Fax Number	:	951-689-4800

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2010
Last Update Date	:	08/13/2021

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