Provider Demographics
NPI:1619114691
Name:ZAMORA, JESS ALEXANDER (AS)
Entity Type:Individual
Prefix:
First Name:JESS
Middle Name:ALEXANDER
Last Name:ZAMORA
Suffix:
Gender:M
Credentials:AS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3670 MCCALL AVE
Mailing Address - Street 2:APT. 114
Mailing Address - City:SELMA
Mailing Address - State:CA
Mailing Address - Zip Code:93662-4170
Mailing Address - Country:US
Mailing Address - Phone:559-819-0913
Mailing Address - Fax:
Practice Address - Street 1:3636 N 1ST ST
Practice Address - Street 2:SUITE 135
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-6800
Practice Address - Country:US
Practice Address - Phone:559-225-1464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1204380615101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)