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General NPI Number Information
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NPI Number | 1417496563
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Entity Type | Individual
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Provider Name | MAVERICK ZAMORA M.S., CCC-SLP
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Gender | Male
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Dates
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Enumeration Date | 02/21/2017
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Last Update Date | 02/21/2017
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Provider Practice Location Address
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Address Line | 78030 CALLE BARCELONA SUITE F
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City | LA QUINTA
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State | CA
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Zip | 92253-2996
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Country | US
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Telephone | 760-799-6186
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Fax |
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Provider Business Mailing Address
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Address Line | 31380 AVENIDA VALDEZ
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City | CATHEDRAL CITY
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State | CA
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Zip | 92234-2783
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Country | US
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Telephone |
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 23986
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License Number State | CA
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