Provider Demographics
NPI:1215905369
Name:ZANO, JOVEN MARQUEZ (IDC)
Entity type:Individual
Prefix:
First Name:JOVEN
Middle Name:MARQUEZ
Last Name:ZANO
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6431 SEWELLS POINT RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23513-3217
Mailing Address - Country:US
Mailing Address - Phone:757-343-2234
Mailing Address - Fax:
Practice Address - Street 1:PSC 561 BOX 1001
Practice Address - Street 2:FPO AP 96310
Practice Address - City:IWAKUNI
Practice Address - State:YAMAGUCHI
Practice Address - Zip Code:96310
Practice Address - Country:JP
Practice Address - Phone:8182-721-4171
Practice Address - Fax:253-5122
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman