Healthcare Provider Details

I. General information

NPI: 1891773834
Provider Name (Legal Business Name): ANTONIO ZAMBOANGA LUZA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2951 FULTON AVE
SACRAMENTO CA
95821-4909
US

IV. Provider business mailing address

2951 FULTON AVE
SACRAMENTO CA
95821-4909
US

V. Phone/Fax

Practice location:
  • Phone: 916-486-7555
  • Fax: 916-486-7557
Mailing address:
  • Phone: 916-486-7555
  • Fax: 916-486-7557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10062
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: