Provider Demographics
NPI:1609389469
Name:ZAMUDIO ESCAMILLA, JOSE JESUS (SA-C)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:JESUS
Last Name:ZAMUDIO ESCAMILLA
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9280 BIG RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509-4969
Mailing Address - Country:US
Mailing Address - Phone:323-820-8540
Mailing Address - Fax:
Practice Address - Street 1:9280 BIG RIDGE RD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92509-4969
Practice Address - Country:US
Practice Address - Phone:323-820-8540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17-578246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant