Provider Demographics
NPI:1528551264
Name:MARDONES, ZANDRA YUVOZKA
Entity type:Individual
Prefix:
First Name:ZANDRA
Middle Name:YUVOZKA
Last Name:MARDONES
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:PO BOX 1113
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95611-1113
Mailing Address - Country:US
Mailing Address - Phone:916-796-7194
Mailing Address - Fax:
Practice Address - Street 1:7566 GREENBACK LN APT 302
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-5645
Practice Address - Country:US
Practice Address - Phone:916-796-7194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA178707164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse