Provider Demographics
NPI:1689885675
Name:ZAMBRANO, FIORELLA M (PA)
Entity Type:Individual
Prefix:
First Name:FIORELLA
Middle Name:M
Last Name:ZAMBRANO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9939 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3528
Mailing Address - Country:US
Mailing Address - Phone:951-354-3216
Mailing Address - Fax:951-848-9968
Practice Address - Street 1:502 W HOLT AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-3604
Practice Address - Country:US
Practice Address - Phone:909-620-8500
Practice Address - Fax:909-620-5799
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16142363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF94071OtherMEDICARE UPIN GROUP
CAGR0083640/GR0083641OtherMEDICAL GROUP
CAZZZ19972Z/ZZZ0075ZOtherMEDICARE GROUP