Healthcare Provider Details

I. General information

NPI: 1427493279
Provider Name (Legal Business Name): JOEL SANTOS ZAMORA M.A MFTI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 05/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N EUCLID ST STE 300
ANAHEIM CA
92801-5514
US

IV. Provider business mailing address

24211 BARK ST
LAKE FOREST CA
92630-5226
US

V. Phone/Fax

Practice location:
  • Phone: 714-871-5646
  • Fax:
Mailing address:
  • Phone: 949-235-6172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number74508
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: