Healthcare Provider Details

I. General information

NPI: 1710946934
Provider Name (Legal Business Name): ZORAYA OBONG ZUNIGA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 COTTAGE AVE SUITE 103
MANTECA CA
95336-4935
US

IV. Provider business mailing address

806 N DEL PRADO ST
MOUNTAIN HOUSE CA
95391-1257
US

V. Phone/Fax

Practice location:
  • Phone: 209-624-5800
  • Fax:
Mailing address:
  • Phone: 510-462-8297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA52552
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: