Healthcare Provider Details

I. General information

NPI: 1013816248
Provider Name (Legal Business Name): FERNANDO S GONZALEZ ZAMORA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2026
Last Update Date: 11/03/2026
Certification Date: 11/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 N 33RD AVE
PHOENIX AZ
85017-5202
US

IV. Provider business mailing address

3001 N 33RD AVE
PHOENIX AZ
85017-5202
US

V. Phone/Fax

Practice location:
  • Phone: 602-353-0703
  • Fax:
Mailing address:
  • Phone: 602-353-0703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number25149
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: