Healthcare Provider Details

I. General information

NPI: 1407677792
Provider Name (Legal Business Name): DONALD ZAMORA LOPEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8803 TAMIAMI TRL E
NAPLES FL
34113-3347
US

IV. Provider business mailing address

3615 CRESTWOOD LAKE AVE APT 203
FORT MYERS FL
33901-8444
US

V. Phone/Fax

Practice location:
  • Phone: 239-272-0838
  • Fax: 239-310-2045
Mailing address:
  • Phone: 239-722-9826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-378854
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: