Healthcare Provider Details

I. General information

NPI: 1750512638
Provider Name (Legal Business Name): JENNIFER ZAMORA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7392 MAGNOLIA AVE
RIVERSIDE CA
92504
US

IV. Provider business mailing address

6950 BROCKTON AVENUE SUITE 5
RIVERSIDE CA
92506
US

V. Phone/Fax

Practice location:
  • Phone: 951-352-3330
  • Fax: 951-352-3303
Mailing address:
  • Phone: 951-686-8223
  • Fax: 951-686-9617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number20390
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: