Provider Demographics
NPI:1215102645
Name:ZENIZO, AMY LYN (LM)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYN
Last Name:ZENIZO
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 E WATER ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2612
Mailing Address - Country:US
Mailing Address - Phone:520-271-3008
Mailing Address - Fax:
Practice Address - Street 1:4525 E WATER ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2612
Practice Address - Country:US
Practice Address - Phone:520-291-2982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-27
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ12101326171R00000X
AZ0108176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No171R00000XOther Service ProvidersInterpreter