Provider Demographics
NPI:1396865523
Name:ZAMORA, MAURICIO (PHARMACY TECH)
Entity Type:Individual
Prefix:MR
First Name:MAURICIO
Middle Name:
Last Name:ZAMORA
Suffix:
Gender:M
Credentials:PHARMACY TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 S. SAN PEDRO STREET
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90011
Mailing Address - Country:US
Mailing Address - Phone:213-749-4174
Mailing Address - Fax:213-749-8818
Practice Address - Street 1:2105 S SAN PEDRO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011-1125
Practice Address - Country:US
Practice Address - Phone:213-749-4174
Practice Address - Fax:213-749-8818
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45110183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician