Provider Demographics
NPI:1881169712
Name:ZAMORA, JOSE BENITO (CBHCM)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:BENITO
Last Name:ZAMORA
Suffix:
Gender:M
Credentials:CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11401 SW 40TH ST STE 345
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3372
Mailing Address - Country:US
Mailing Address - Phone:305-603-7063
Mailing Address - Fax:305-603-8705
Practice Address - Street 1:11401 SW 40TH ST STE 345
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3372
Practice Address - Country:US
Practice Address - Phone:305-603-7063
Practice Address - Fax:305-603-8705
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-08
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
FL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101121800Medicaid