Provider Demographics
NPI:1891073201
Name:CACCAVALE ZAMBEL, RENE (RDH)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:
Last Name:CACCAVALE ZAMBEL
Suffix:
Gender:F
Credentials:RDH
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 655
Mailing Address - Street 2:
Mailing Address - City:TWIN PEAKS
Mailing Address - State:CA
Mailing Address - Zip Code:92391-0655
Mailing Address - Country:US
Mailing Address - Phone:909-557-5598
Mailing Address - Fax:
Practice Address - Street 1:561 GRANDVIEW RD
Practice Address - Street 2:
Practice Address - City:TWIN PEAKS
Practice Address - State:CA
Practice Address - Zip Code:92391-0900
Practice Address - Country:US
Practice Address - Phone:909-557-5598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHAP 37OtherRD HAP DENTAL HYGIENIST