Provider Demographics
NPI:1295112472
Name:ZAMORA, HERIBERTO JR (ATC)
Entity type:Individual
Prefix:
First Name:HERIBERTO
Middle Name:
Last Name:ZAMORA
Suffix:JR
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15410 SCHUMANN LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-5452
Mailing Address - Country:US
Mailing Address - Phone:832-671-6548
Mailing Address - Fax:
Practice Address - Street 1:15410 SCHUMANN LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-5452
Practice Address - Country:US
Practice Address - Phone:832-671-6548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14602255A2300X
TX62802255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer