1346018322 NPI number — JULIANA ZAMORA, MASTERS STUDENT INTERN

Table of content: JULIANA ZAMORA, MASTERS STUDENT INTERN (NPI 1346018322)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346018322 NPI number — JULIANA ZAMORA, MASTERS STUDENT INTERN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZAMORA, MASTERS STUDENT INTERN
Provider First Name:
JULIANA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346018322
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 LA VEGA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOCORRO
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87801-5019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-518-8034
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 US-60
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOCORRO
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-835-2444
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/19/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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