MEDICARE: MR. ANTONIO ZAMBOANGA LUZA PA-C

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	10062	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10062	OTHER	CA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1891773834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTONIO ZAMBOANGA LUZA PA-C

Provider Business Mailing Address
First Line	:	2951 FULTON AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95821-4909
Country	:	US
Telephone Number	:	916-486-7555
Fax Number	:	916-486-7557

Provider Business Practice Location Address
First Line	:	2951 FULTON AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95821-4909
Country	:	US
Telephone Number	:	916-486-7555
Fax Number	:	916-486-7557

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

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	09/28/2022

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Directions to “ MR. ANTONIO ZAMBOANGA LUZA PA-C” Practice Location

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