Provider Demographics
NPI:1891951091
Name:ZARANDONA, J MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:MANUEL
Last Name:ZARANDONA
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:5121 COTTONWOOD ST
Mailing Address - Street 2:INTERMOUNTAIN MEDICAL CENTER DEPT. OF PATHOLOGY
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5701
Mailing Address - Country:US
Mailing Address - Phone:801-507-7970
Mailing Address - Fax:801-507-7996
Practice Address - Street 1:5121 COTTONWOOD ST
Practice Address - Street 2:INTERMOUNTAIN MEDICAL CENTER DEPT. OF PATHOLOGY
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5701
Practice Address - Country:US
Practice Address - Phone:801-507-7970
Practice Address - Fax:801-507-7996
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT287202-1205207ZP0102X, 207ZD0900X
PAMD430434207ZD0900X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID808368300Medicaid
OK200246920AMedicaid
CO58089058Medicaid
CO58089058Medicaid