Provider Demographics
NPI:1922784586
Name:MACIAS ZAMBRANO, IVETTE J
Entity Type:Individual
Prefix:
First Name:IVETTE
Middle Name:J
Last Name:MACIAS ZAMBRANO
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 1:7150 SEMINOLE BLVD
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-5935
Mailing Address - Country:US
Mailing Address - Phone:727-335-1556
Mailing Address - Fax:
Practice Address - Street 1:7150 SEMINOLE BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-5935
Practice Address - Country:US
Practice Address - Phone:727-335-1556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician