Healthcare Provider Details

I. General information

NPI: 1437308996
Provider Name (Legal Business Name): GABRIEL KIM ZAMACONA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 03/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 6TH STREET
POINT REYES STATION CA
94956-0000
US

IV. Provider business mailing address

PO BOX 331
POINT REYES STATION CA
94956-0331
US

V. Phone/Fax

Practice location:
  • Phone: 415-663-8231
  • Fax:
Mailing address:
  • Phone: 415-663-8231
  • 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: