Provider Demographics
NPI:1750754834
Name:ZAMBINO, THERESA
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:ZAMBINO
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 1:769 SW 19TH ST
Mailing Address - Street 2:APT. 13102
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-3046
Mailing Address - Country:US
Mailing Address - Phone:330-219-2924
Mailing Address - Fax:
Practice Address - Street 1:6501 NE 50TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73141-9118
Practice Address - Country:US
Practice Address - Phone:405-605-6111
Practice Address - Fax:405-427-0351
Is Sole Proprietor?:No
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator