Provider Demographics
NPI:1124561410
Name:ZAMBAKARI, ARKETA
Entity type:Individual
Prefix:MS
First Name:ARKETA
Middle Name:
Last Name:ZAMBAKARI
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 1:4123 N 21ST ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-6109
Mailing Address - Country:US
Mailing Address - Phone:602-321-3616
Mailing Address - Fax:
Practice Address - Street 1:4123 N 21ST ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-6109
Practice Address - Country:US
Practice Address - Phone:602-321-3616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL10165H376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAL10165HOtherDEPARTMENT OF HEALTH SERVICES