Provider Demographics
NPI:1134634777
Name:ZAMORA, VINCENT PATRICK
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:PATRICK
Last Name:ZAMORA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 N 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-5411
Mailing Address - Country:US
Mailing Address - Phone:509-531-1759
Mailing Address - Fax:509-545-8076
Practice Address - Street 1:224 N 7TH AVE
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-5411
Practice Address - Country:US
Practice Address - Phone:509-531-1759
Practice Address - Fax:509-545-8076
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-05
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK6937712OtherDRIVER LICENSE