Basic Information
| Provider Information | |||||||||
| NPI: | 1689885675 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZAMBRANO | ||||||||
| FirstName: | FIORELLA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9939 MAGNOLIA AVE | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925033528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513543216 | ||||||||
| FaxNumber: | 9518489968 | ||||||||
| Practice Location | |||||||||
| Address1: | 502 W HOLT AVE | ||||||||
| Address2: | |||||||||
| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917683604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9096208500 | ||||||||
| FaxNumber: | 9096205799 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2007 | ||||||||
| LastUpdateDate: | 12/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 16142 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | F94071 | 01 | CA | MEDICARE UPIN GROUP | OTHER | GR0083640/GR0083641 | 01 | CA | MEDICAL GROUP | OTHER | ZZZ19972Z/ZZZ0075Z | 01 | CA | MEDICARE GROUP | OTHER |