Healthcare Provider Details

I. General information

NPI: 1417286725
Provider Name (Legal Business Name): FERNANDO A ZAMUDIO MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6655 ALVARADO RD
SAN DIEGO CA
92120-5208
US

IV. Provider business mailing address

PO BOX 22211
SAN DIEGO CA
92192-2211
US

V. Phone/Fax

Practice location:
  • Phone: 760-230-1353
  • Fax: 760-230-6283
Mailing address:
  • Phone: 760-230-1353
  • Fax: 760-230-6283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberC26245
License Number StateCA

VIII. Authorized Official

Name: FERNANDO ANTONIO ZAMUDIO
Title or Position: PRESIDENT
Credential: MD
Phone: 619-583-0511