Provider Demographics
NPI:1023751054
Name:ZAMBRANO, PERI PARK
Entity type:Individual
Prefix:
First Name:PERI
Middle Name:PARK
Last Name: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 1:75 N WOODWARD AVE # 3989
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32313-7500
Mailing Address - Country:US
Mailing Address - Phone:305-794-1669
Mailing Address - Fax:
Practice Address - Street 1:824 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32304-8018
Practice Address - Country:US
Practice Address - Phone:305-794-1669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst