Provider Demographics
NPI:1750432852
Name:ZAMORA, JOEL MALLARI (PT)
Entity type:Individual
Prefix:MR
First Name:JOEL
Middle Name:MALLARI
Last Name:ZAMORA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:256 CAJON ST STE G
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5278
Mailing Address - Country:US
Mailing Address - Phone:909-810-0185
Mailing Address - Fax:714-475-2877
Practice Address - Street 1:256 CAJON ST STE G
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5278
Practice Address - Country:US
Practice Address - Phone:909-810-0185
Practice Address - Fax:714-475-2877
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28321225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist