Provider Demographics
NPI:1669888228
Name:ZUNIGA, MA. ANGELICA DIAZ
Entity type:Individual
Prefix:
First Name:MA. ANGELICA
Middle Name:DIAZ
Last Name:ZUNIGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGELICA
Other - Middle Name:DIAZ
Other - Last Name:ZUNIGA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:5900 W SAMPLE RD
Mailing Address - Street 2:APT 304
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-3248
Mailing Address - Country:US
Mailing Address - Phone:954-345-7040
Mailing Address - Fax:
Practice Address - Street 1:5900 W SAMPLE RD
Practice Address - Street 2:APT 304
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-3248
Practice Address - Country:US
Practice Address - Phone:954-345-7040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-03
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035935225100000X
TX1256137225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist