Provider Demographics
NPI:1760565832
Name:MALANA, ZOZIMO R
Entity Type:Individual
Prefix:MR
First Name:ZOZIMO
Middle Name:R
Last Name:MALANA
Suffix:
Gender:M
Credentials:
Other - Prefix:MS
Other - First Name:ZOZIMO
Other - Middle Name:R
Other - Last Name:MALANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12234 CLYDESDALE DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-9041
Mailing Address - Country:US
Mailing Address - Phone:909-899-0157
Mailing Address - Fax:909-463-9242
Practice Address - Street 1:12234 CLYDESDALE DR
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-9041
Practice Address - Country:US
Practice Address - Phone:909-899-0157
Practice Address - Fax:909-463-9242
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTN01121FMedicaid