Provider Demographics
NPI:1174681829
Name:ZAMBRANO, MARIA
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:
Last Name:ZAMBRANO
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 1:5603 W SHANGRI LA RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-3851
Mailing Address - Country:US
Mailing Address - Phone:623-979-1150
Mailing Address - Fax:
Practice Address - Street 1:5603 W SHANGRI LA RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-3851
Practice Address - Country:US
Practice Address - Phone:623-979-1150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11355385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ116658OtherACCCHS ID. NUMBER