MEDICARE: ZENRA MAE MALLO LERIT

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	163W00000X	Registered Nurse	R191364	MP

General Provider Information

NPI Number	:	1922979103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZENRA MAE MALLO LERIT

Provider Business Mailing Address
First Line	:	2025 WATSON AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10472-5403
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2025 WATSON AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10472-5403
Country	:	US
Telephone Number	:	347-493-4632
Fax Number	:

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

Provider Enumeration Date	:	09/12/2025
Last Update Date	:	10/24/2025

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Directions to “ ZENRA MAE MALLO LERIT ” Practice Location

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