Provider Demographics
NPI:1093043176
Name:VANDERZIEL, MARIBEL PICARDO
Entity Type:Individual
Prefix:
First Name:MARIBEL
Middle Name:PICARDO
Last Name:VANDERZIEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3670 S TOWER AVE
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-2672
Mailing Address - Country:US
Mailing Address - Phone:480-802-4196
Mailing Address - Fax:480-802-4196
Practice Address - Street 1:3670 S TOWER AVE
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-2672
Practice Address - Country:US
Practice Address - Phone:480-802-4196
Practice Address - Fax:480-802-4196
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1000007729376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide