Provider Demographics
NPI:1881162949
Name:ZAMORA, BENJAMIN SERJIO
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:SERJIO
Last Name:ZAMORA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 NW AUGUSTA SQ
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1268
Mailing Address - Country:US
Mailing Address - Phone:361-459-9395
Mailing Address - Fax:
Practice Address - Street 1:1217 W HOUSTON AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-5012
Practice Address - Country:US
Practice Address - Phone:956-631-9171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113879235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist