Provider Demographics
NPI:1588932297
Name:ZAMORA, PAUL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:ZAMORA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13170 LINCOLN ST NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-4124
Mailing Address - Country:US
Mailing Address - Phone:763-370-7570
Mailing Address - Fax:
Practice Address - Street 1:1061 109TH AVE NE STE D
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-3847
Practice Address - Country:US
Practice Address - Phone:763-208-4562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist