Provider Demographics
NPI:1285325357
Name:ZAMBRANO, TIANNA (SLP)
Entity type:Individual
Prefix:
First Name:TIANNA
Middle Name:
Last Name:ZAMBRANO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 OAK ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3769
Mailing Address - Country:US
Mailing Address - Phone:575-523-2288
Mailing Address - Fax:575-523-2299
Practice Address - Street 1:390 CALLE DE ALEGRA STE C
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3280
Practice Address - Country:US
Practice Address - Phone:575-635-4778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCF7903235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist