Provider Demographics
NPI:1417496563
Name:ZAMORA, MAVERICK (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MAVERICK
Middle Name:
Last Name:ZAMORA
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31380 AVENIDA VALDEZ
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-2783
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:78030 CALLE BARCELONA
Practice Address - Street 2:SUITE F
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2996
Practice Address - Country:US
Practice Address - Phone:760-799-6186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23986235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist