Provider Demographics
NPI:1467825984
Name:ZAMORA, NICHOLAS (MS)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:ZAMORA
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5203 JUAN TABO BLVD NE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2683
Mailing Address - Country:US
Mailing Address - Phone:505-266-6121
Mailing Address - Fax:
Practice Address - Street 1:5203 JUAN TABO BLVD NE
Practice Address - Street 2:SUITE 2A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2683
Practice Address - Country:US
Practice Address - Phone:505-266-6121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0177401101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health