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General NPI Number Information
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NPI Number | 1265395552
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Entity Type | Individual
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Provider Name | MR. NICASIO ZAMORA
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Gender | Male
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Dates
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Enumeration Date | 12/04/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 480 CHADBOURNE RD
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City | FAIRFIELD
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State | CA
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Zip | 94534-9639
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Country | US
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Telephone | 510-317-1444
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4072
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City | ANTIOCH
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State | CA
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Zip | 94531-4072
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Country | US
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Telephone | 925-206-9194
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 146605
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License Number State | CA
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