Doctor Name: | MADONNA ZAND |
NPI Number: | 1023493095 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 95002602 |
Business Practice Address: | 1310 San Bernardino Rd 205 Upland, CA - 917864979 |
Business Phone Number: | 9099819991 |
Business Fax Number: | |
Mailing Address: | 9367 Hemlock St, RANCHO CUCAMONGA |
State: | CA |
Postal Code: | 917302610 |
Phone Number: | 6264233663 |
Fax Number: | |
NPI Enumeration Date: | 07/20/2015 |
NPI Last Update Date: | 07/20/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 95002602 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |