Provider Demographics
NPI:1730550146
Name:ZAZUETA, JENNIFER (CSFA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ZAZUETA
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 21449
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85277
Mailing Address - Country:US
Mailing Address - Phone:480-221-4815
Mailing Address - Fax:480-985-6247
Practice Address - Street 1:4126 E NIGHTHAWK WAY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048
Practice Address - Country:US
Practice Address - Phone:480-720-8602
Practice Address - Fax:480-365-0507
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-12
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZC0007X246ZC0007X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant