Individual
CODI BANZACA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2412 6TH AVE, TOMS RIVER, NJ 08753-6034
(732) 267-3180
Mailing address
2412 6TH AVE, TOMS RIVER, NJ 08753-6034
(732) 267-3180
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
26NP07284900
NJ
Other
Enumeration date
05/22/2023
Last updated
05/22/2023
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