Provider Demographics
NPI:1578924676
Name:ZAMORA, SILVESTRE MARQUES JR
Entity Type:Individual
Prefix:
First Name:SILVESTRE
Middle Name:MARQUES
Last Name:ZAMORA
Suffix:JR
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 1:1212 N CALIFORNIA ST
Mailing Address - Street 2:INPT. ADMIN
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-1552
Mailing Address - Country:US
Mailing Address - Phone:209-468-8739
Mailing Address - Fax:209-468-9854
Practice Address - Street 1:1212 N CALIFORNIA ST
Practice Address - Street 2:INPT. ADMIN
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1552
Practice Address - Country:US
Practice Address - Phone:209-468-8739
Practice Address - Fax:209-468-9854
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health