Healthcare Provider Details

I. General information

NPI: 1821027699
Provider Name (Legal Business Name): LILIA ZAMORA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2603 VIA CAMPO
MONTEBELLO CA
90640-1807
US

IV. Provider business mailing address

2603 VIA CAMPO
MONTEBELLO CA
90640-1807
US

V. Phone/Fax

Practice location:
  • Phone: 323-720-1144
  • Fax: 323-720-5596
Mailing address:
  • Phone: 323-720-1144
  • Fax: 323-720-5596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG068059
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: