Provider Demographics
NPI:1336653294
Name:ZANZI, INSIYAH
Entity Type:Individual
Prefix:DR
First Name:INSIYAH
Middle Name:
Last Name:ZANZI
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 1:1424 BLUE OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-7143
Mailing Address - Country:US
Mailing Address - Phone:916-797-0825
Mailing Address - Fax:916-797-0895
Practice Address - Street 1:1424 BLUE OAKS BLVD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-7143
Practice Address - Country:US
Practice Address - Phone:916-797-0825
Practice Address - Fax:916-797-0895
Is Sole Proprietor?:No
Enumeration Date:2017-11-29
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46224122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA52133OtherBLUE SHIELD OF CA