Provider Demographics
NPI:1770642621
Name:ZAMARRA, CAROL ANN (ND, LMT)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANN
Last Name:ZAMARRA
Suffix:
Gender:F
Credentials:ND, LMT
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3835 SW 185TH AVE, SUITE 200
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97078
Mailing Address - Country:US
Mailing Address - Phone:503-591-8855
Mailing Address - Fax:503-591-1595
Practice Address - Street 1:3835 SW 185TH AVE, SUITE 200
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97078
Practice Address - Country:US
Practice Address - Phone:503-591-8855
Practice Address - Fax:503-591-1595
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10311225700000X
OR1519175F00000X
OR175F00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist