Basic Information
| Provider Information | |||||||||
| NPI: | 1295931772 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZARRILLO | ||||||||
| FirstName: | IVETTE | ||||||||
| MiddleName: | MARGARITA | ||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LAMBOY MEDINA | ||||||||
| OtherFirstName: | IVETTE | ||||||||
| OtherMiddleName: | MARGARITA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1484 STRAITS DR STE 5 | ||||||||
| Address2: | |||||||||
| City: | BAY CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487068718 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1484 STRAITS DR STE 5 | ||||||||
| Address2: | |||||||||
| City: | BAY CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487068718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9896678740 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2007 | ||||||||
| LastUpdateDate: | 01/13/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 11990 | PR | N | Allopathic & Osteopathic Physicians | General Practice | 208D00000X | 4301108932 | MI | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.