Healthcare Provider Details

I. General information

NPI: 1871233593
Provider Name (Legal Business Name): EDUARDO ZAMORA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9377 HAVEN AVE STE 100
RANCHO CUCAMONGA CA
91730-5340
US

IV. Provider business mailing address

9377 HAVEN AVE STE 100
RANCHO CUCAMONGA CA
91730-5340
US

V. Phone/Fax

Practice location:
  • Phone: 909-906-1505
  • Fax: 909-906-1508
Mailing address:
  • Phone: 909-906-1505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: