Healthcare Provider Details

I. General information

NPI: 1891466397
Provider Name (Legal Business Name): JOSE DANIEL ZAMORA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 09/23/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13944 S ACADEMY AVE
KINGSBURG CA
93631-9207
US

IV. Provider business mailing address

12406 S GOLDEN STATE BLVD.
SELMA CA
93662
US

V. Phone/Fax

Practice location:
  • Phone: 559-556-0030
  • Fax:
Mailing address:
  • Phone: 559-819-9657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: