Healthcare Provider Details

I. General information

NPI: 1699009167
Provider Name (Legal Business Name): NOEL M ZOMALAN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2161 COLORADO AVE SUITE A
TURLOCK CA
95382-2007
US

IV. Provider business mailing address

PO BOX 4398
MODESTO CA
95352-4398
US

V. Phone/Fax

Practice location:
  • Phone: 209-575-4575
  • Fax: 209-529-3260
Mailing address:
  • Phone: 209-575-4575
  • Fax: 209-529-3260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA96546
License Number StateCA

VIII. Authorized Official

Name: JUNE ADAMS
Title or Position: OFFICE MANAGER
Credential:
Phone: 209-575-4575