Provider Demographics
NPI:1861158552
Name:LUNA ZAMBRANO, ANDREA ESTEFANIA
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:ESTEFANIA
Last Name:LUNA 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 1:1107 COVENTRY WAY APT D
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-9077
Mailing Address - Country:US
Mailing Address - Phone:786-450-9568
Mailing Address - Fax:
Practice Address - Street 1:1107 COVENTRY WAY APT D
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-9077
Practice Address - Country:US
Practice Address - Phone:786-450-9568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21-624246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant