Healthcare Provider Details

I. General information

NPI: 1801466933
Provider Name (Legal Business Name): RICHARD C ZAMORA PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NEW STINE RD STE 120
BAKERSFIELD CA
93309-2657
US

IV. Provider business mailing address

200 NEW STINE RD STE 120
BAKERSFIELD CA
93309-2657
US

V. Phone/Fax

Practice location:
  • Phone: 702-321-5158
  • Fax:
Mailing address:
  • Phone: 702-321-5158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number29964
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number29964
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number29964
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number29964
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: