Provider Demographics
NPI:1861004285
Name:ZAMBRANA, GLORILIS SR
Entity type:Individual
Prefix:
First Name:GLORILIS
Middle Name:
Last Name:ZAMBRANA
Suffix:SR
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 1:1C-14B SUITE 138 LOMAS VERDES
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-217-9875
Mailing Address - Fax:
Practice Address - Street 1:CARR. 174 KM 15.3 BARRIO GUARAGUAO ARRIBA
Practice Address - Street 2:SECTOR CHORRERA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-217-9875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR148991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical