Provider Demographics
NPI:1386739167
Name:AMATO, ZANDRA ROLON (DC IDE QME)
Entity type:Individual
Prefix:DR
First Name:ZANDRA
Middle Name:ROLON
Last Name:AMATO
Suffix:
Gender:F
Credentials:DC IDE QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4841 SOQUEL DRIVE
Mailing Address - Street 2:
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073
Mailing Address - Country:US
Mailing Address - Phone:831-476-2303
Mailing Address - Fax:831-476-2305
Practice Address - Street 1:4841 SOQUEL DRIVE
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073
Practice Address - Country:US
Practice Address - Phone:831-476-2303
Practice Address - Fax:831-476-2305
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0208550111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0208550Medicare ID - Type Unspecified