Provider Demographics
NPI:1215207956
Name:ZAMORA, PEDRO EFREN (CSA)
Entity Type:Individual
Prefix:MR
First Name:PEDRO
Middle Name:EFREN
Last Name:ZAMORA
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11645 MONUMENT DR UNIT 1138
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34211-1281
Mailing Address - Country:US
Mailing Address - Phone:360-914-6048
Mailing Address - Fax:
Practice Address - Street 1:11645 MONUMENT DR UNIT 1138
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34211-1281
Practice Address - Country:US
Practice Address - Phone:360-914-6048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant