Provider Demographics
NPI:1407932809
Name:ZAMBRANA, FERNANDO A
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:A
Last Name:ZAMBRANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 COLL Y TOSTE ST
Mailing Address - Street 2:UR6 BALDRICH HATO REY
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-4015
Mailing Address - Country:US
Mailing Address - Phone:787-753-7920
Mailing Address - Fax:787-764-2482
Practice Address - Street 1:255 COLL Y TOSTE ST
Practice Address - Street 2:UR6 BALDRICH HATO REY
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4015
Practice Address - Country:US
Practice Address - Phone:787-753-7920
Practice Address - Fax:787-764-2482
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR945122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist