Provider Demographics
NPI:1689730970
Name:ZAMORA, MIGUEL (RDHAP)
Entity Type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:
Last Name:ZAMORA
Suffix:
Gender:M
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 LINDSEY AVE
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-1724
Mailing Address - Country:US
Mailing Address - Phone:562-522-5227
Mailing Address - Fax:
Practice Address - Street 1:4025 LINDSEY AVE
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-1724
Practice Address - Country:US
Practice Address - Phone:562-522-5227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP139124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH00139-01Medicare ID - Type UnspecifiedDENTI-CAL BILLING PROVIDE