Healthcare Provider Details

I. General information

NPI: 1255723250
Provider Name (Legal Business Name): BELEM ZAMORA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2015
Last Update Date: 02/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1461 E COOLEY DR SUITE 100
COLTON CA
92324-3921
US

IV. Provider business mailing address

3611 S HARBOR BLVD SUITE 100
SANTA ANA CA
92704-6928
US

V. Phone/Fax

Practice location:
  • Phone: 909-835-4800
  • Fax: 909-835-4997
Mailing address:
  • Phone: 714-966-8650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: