Provider Demographics
NPI:1477711547
Name:ZAMORA, MIGUEL A
Entity Type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:A
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 1:935 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-2349
Mailing Address - Country:US
Mailing Address - Phone:760-482-4452
Mailing Address - Fax:760-352-9933
Practice Address - Street 1:935 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-2349
Practice Address - Country:US
Practice Address - Phone:760-482-4452
Practice Address - Fax:760-352-9933
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16335176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife