Healthcare Provider Details

I. General information

NPI: 1548032006
Provider Name (Legal Business Name): ADAM K ZAMORA AGNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2023
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 W BROWN RD STE 1011
MESA AZ
85201-3222
US

IV. Provider business mailing address

3273 E WILDHORSE DR
GILBERT AZ
85297-9301
US

V. Phone/Fax

Practice location:
  • Phone: 480-864-3671
  • Fax: 480-520-7762
Mailing address:
  • Phone: 480-235-7327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number299495
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number299495
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number299495
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: