Provider Demographics
NPI:1093167371
Name:ZAMORANO, GRACE PAGARAN (FNP-C)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:PAGARAN
Last Name:ZAMORANO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10535 FOOTHILL BLVD
Mailing Address - Street 2:#270
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3843
Mailing Address - Country:US
Mailing Address - Phone:323-627-3943
Mailing Address - Fax:
Practice Address - Street 1:10787 LAUREL ST
Practice Address - Street 2:#270
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3828
Practice Address - Country:US
Practice Address - Phone:909-982-7741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004316372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider