Provider Demographics
NPI:1417608423
Name:ZAMORA, LUCERO ANAHI (PA)
Entity Type:Individual
Prefix:MRS
First Name:LUCERO
Middle Name:ANAHI
Last Name:ZAMORA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:LUCERO
Other - Middle Name:
Other - Last Name:ROSALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 BREWSTER BLVD
Mailing Address - Street 2:
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28547-2575
Mailing Address - Country:US
Mailing Address - Phone:910-449-2610
Mailing Address - Fax:
Practice Address - Street 1:FC309B MEDICAL TRAILER HM SMITH BLVD
Practice Address - Street 2:
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28547-2575
Practice Address - Country:US
Practice Address - Phone:910-451-5125
Practice Address - Fax:910-451-0698
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant