Provider Demographics
NPI:1528398427
Name:ZUNIGA, WENDY
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:ZUNIGA
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:PO BOX 1063
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88004-1063
Mailing Address - Country:US
Mailing Address - Phone:575-915-6313
Mailing Address - Fax:575-882-1879
Practice Address - Street 1:880 ANTHONY DR STE 3E
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:NM
Practice Address - Zip Code:88021-9346
Practice Address - Country:US
Practice Address - Phone:575-882-5290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM125179070172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker