Provider Demographics
NPI: | 1508815531 |
---|---|
Name: | ZAMBRANO, MARIO D (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | MARIO |
Middle Name: | D |
Last Name: | ZAMBRANO |
Suffix: | |
Gender: | M |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 975 BAPTIST WAY |
Mailing Address - Street 2: | |
Mailing Address - City: | HOMESTEAD |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33033-7600 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 786-243-8587 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 975 BAPTIST WAY |
Practice Address - Street 2: | |
Practice Address - City: | HOMESTEAD |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33033-7600 |
Practice Address - Country: | US |
Practice Address - Phone: | 786-243-8587 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-05-08 |
Last Update Date: | 2022-06-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | ME68860 | 208000000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 378700100 | Medicaid | |
FL | 035738 | Other | NHP |
FL | 378700100 | Other | EMI NETPASS PSN |
FL | 378700100 | Other | FLORIDA NETPASS PSN |
FL | 4570734 | Other | GHI |
FL | 27742 | Other | BCBS |
FL | 214763 | Other | AVMED |
FL | 6328638 | Other | CIGNA |
FL | 214763 | Other | AVMED |