Provider Demographics
NPI:1346034568
Name:ZAMUDIO, JOSE NATIVIDAD JR (MSW STUDENT, PPS)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:NATIVIDAD
Last Name:ZAMUDIO
Suffix:JR
Gender:
Credentials:MSW STUDENT, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 N SYLMAR AVE APT 107
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-2216
Mailing Address - Country:US
Mailing Address - Phone:559-672-0396
Mailing Address - Fax:
Practice Address - Street 1:1302 E DAKOTA AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-4441
Practice Address - Country:US
Practice Address - Phone:559-248-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-04
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program