MEDICARE: PRINCESS KRYZTAL ALEXYS ZAMORA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1356157051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRINCESS KRYZTAL ALEXYS ZAMORA

Provider Business Mailing Address
First Line	:	7452 W CREST LN
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85310-5619
Country	:	US
Telephone Number	:	831-597-4192
Fax Number	:

Provider Business Practice Location Address
First Line	:	7452 W CREST LN
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85310-5619
Country	:	US
Telephone Number	:	831-597-4192
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2024
Last Update Date	:	05/13/2026

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