Provider Demographics
NPI:1558659474
Name:ZAMORA, CASSANDRA ROSE
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:ROSE
Last Name:ZAMORA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14901 NEWPORT AVE APT 12
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6188
Mailing Address - Country:US
Mailing Address - Phone:714-299-6750
Mailing Address - Fax:
Practice Address - Street 1:14901 NEWPORT AVE APT 12
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6188
Practice Address - Country:US
Practice Address - Phone:714-299-6750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor