Provider Demographics
NPI:1770314221
Name:ZAMBRANO, LUISA DOMINIQUE
Entity type:Individual
Prefix:
First Name:LUISA
Middle Name:DOMINIQUE
Last Name: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 1:23229 HIGHWAY 99 APT D302
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8761
Mailing Address - Country:US
Mailing Address - Phone:503-701-7342
Mailing Address - Fax:
Practice Address - Street 1:118 N 35TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8664
Practice Address - Country:US
Practice Address - Phone:503-701-7342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB61555267106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician