MEDICARE: CLEOTILDE ZAMORA NURSE PRACTITIONER

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	363LF0000X	Family Nurse Practitioner	95004721	CA

General Provider Information

NPI Number	:	1821545070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLEOTILDE ZAMORA NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	10854 DARBY AVE
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91326-2822
Country	:	US
Telephone Number	:	323-272-5138
Fax Number	:

Provider Business Practice Location Address
First Line	:	26777 AGOURA RD
Second Line	:
City	:	CALABASAS
State	:	CA
Zip	:	91302-2967
Country	:	US
Telephone Number	:	818-880-2225
Fax Number	:	818-880-2228

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

Provider Enumeration Date	:	09/06/2016
Last Update Date	:	10/29/2024

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