Provider Demographics
NPI:1457045577
Name:ZAMBARE, PRAJAKTA (PT, DPT)
Entity type:Individual
Prefix:
First Name:PRAJAKTA
Middle Name:
Last Name:ZAMBARE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 NOBEL DR UNIT 2105
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-4575
Mailing Address - Country:US
Mailing Address - Phone:682-330-3306
Mailing Address - Fax:
Practice Address - Street 1:3142 VISTA WAY STE 101
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-3627
Practice Address - Country:US
Practice Address - Phone:760-752-1011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA304097225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist