Provider Demographics
NPI:1063039758
Name:ZYLSTRA, ARIANNA (EMT)
Entity Type:Individual
Prefix:MISS
First Name:ARIANNA
Middle Name:
Last Name:ZYLSTRA
Suffix:
Gender:F
Credentials:EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 FRICOT CITY RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANDREAS
Mailing Address - State:CA
Mailing Address - Zip Code:95249-9642
Mailing Address - Country:US
Mailing Address - Phone:209-736-4500
Mailing Address - Fax:209-736-1800
Practice Address - Street 1:10400 FRICOT CITY RD
Practice Address - Street 2:
Practice Address - City:SAN ANDREAS
Practice Address - State:CA
Practice Address - Zip Code:95249-9642
Practice Address - Country:US
Practice Address - Phone:209-736-4500
Practice Address - Fax:209-736-1800
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE131686146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic