Provider Demographics
NPI:1871209882
Name:ZACCARO, BREANA (CD(DONA))
Entity type:Individual
Prefix:
First Name:BREANA
Middle Name:
Last Name:ZACCARO
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21292 VALEWOOD
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-6461
Mailing Address - Country:US
Mailing Address - Phone:949-300-0433
Mailing Address - Fax:
Practice Address - Street 1:21292 VALEWOOD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-6461
Practice Address - Country:US
Practice Address - Phone:949-300-0433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14800374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula