Healthcare Provider Details

I. General information

NPI: 1275285736
Provider Name (Legal Business Name): ADALBERT ZAMORA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 CAJON ST STE B
REDLANDS CA
92373-5278
US

IV. Provider business mailing address

256 CAJON ST STE B
REDLANDS CA
92373-5278
US

V. Phone/Fax

Practice location:
  • Phone: 909-904-0829
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number610068
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number610068
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number610068
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number610068
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number610068
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number610068
License Number StateCA
# 7
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number610068
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: