Healthcare Provider Details

I. General information

NPI: 1467825984
Provider Name (Legal Business Name): NICHOLAS ZAMORA M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2015
Last Update Date: 11/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5203 JUAN TABO BLVD NE SUITE 2A
ALBUQUERQUE NM
87111-2683
US

IV. Provider business mailing address

5203 JUAN TABO BLVD NE SUITE 2A
ALBUQUERQUE NM
87111-2683
US

V. Phone/Fax

Practice location:
  • Phone: 505-266-6121
  • Fax:
Mailing address:
  • Phone: 505-266-6121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0177401
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: