MEDICARE: BREANA ZACCARO CD(DONA)

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	374J00000X	Doula	14800	IL

General Provider Information

NPI Number	:	1871209882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREANA ZACCARO CD(DONA)

Provider Business Mailing Address
First Line	:	21292 VALEWOOD
Second Line	:
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-6461
Country	:	US
Telephone Number	:	949-300-0433
Fax Number	:

Provider Business Practice Location Address
First Line	:	21292 VALEWOOD
Second Line	:
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-6461
Country	:	US
Telephone Number	:	949-300-0433
Fax Number	:

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

Provider Enumeration Date	:	01/24/2023
Last Update Date	:	01/24/2023

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