Provider Demographics
NPI:1467860734
Name:ZAMORA, GEORGE
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:ZAMORA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 S IMPERIAL AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-4242
Mailing Address - Country:US
Mailing Address - Phone:760-339-2802
Mailing Address - Fax:
Practice Address - Street 1:1503 N IMPERIAL AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-6301
Practice Address - Country:US
Practice Address - Phone:760-339-2802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-30
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001047363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily