Provider Demographics
NPI:1386268845
Name:ZAMORA GONZALEZ, ROXANA (AMFT)
Entity type:Individual
Prefix:
First Name:ROXANA
Middle Name:
Last Name:ZAMORA GONZALEZ
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34052 DOHENY PARK RD SPC 23
Mailing Address - Street 2:
Mailing Address - City:CAPISTRANO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92624-1173
Mailing Address - Country:US
Mailing Address - Phone:949-652-9249
Mailing Address - Fax:
Practice Address - Street 1:23046 AVENIDA DE LA CARLOTA STE 500
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1575
Practice Address - Country:US
Practice Address - Phone:949-643-6913
Practice Address - Fax:949-643-6931
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA131962106H00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program