Provider Demographics
NPI:1205004447
Name:ZALDIVAR, MARCO EDGARDO (RNFA)
Entity Type:Individual
Prefix:
First Name:MARCO
Middle Name:EDGARDO
Last Name:ZALDIVAR
Suffix:
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8915 E PAMPA AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-2834
Mailing Address - Country:US
Mailing Address - Phone:480-636-9223
Mailing Address - Fax:480-686-9223
Practice Address - Street 1:8915 E PAMPA AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-2834
Practice Address - Country:US
Practice Address - Phone:480-636-9223
Practice Address - Fax:480-686-9223
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN122134163W00000X, 163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No163W00000XNursing Service ProvidersRegistered Nurse