Provider Demographics
NPI:1285947358
Name:ZAKALA, MARINA LISA (MD)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:LISA
Last Name:ZAKALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11673 W HEDGEHOG CT
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-2538
Mailing Address - Country:US
Mailing Address - Phone:623-215-4264
Mailing Address - Fax:914-339-8193
Practice Address - Street 1:11673 W HEDGEHOG CT
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2538
Practice Address - Country:US
Practice Address - Phone:623-215-4264
Practice Address - Fax:914-339-8193
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ188632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry