Provider Demographics
NPI:1699009167
Name:NOEL M ZOMALAN MD INC
Entity type:Organization
Organization Name:NOEL M ZOMALAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-575-4575
Mailing Address - Street 1:PO BOX 4398
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95352-4398
Mailing Address - Country:US
Mailing Address - Phone:209-575-4575
Mailing Address - Fax:209-529-3260
Practice Address - Street 1:2161 COLORADO AVE
Practice Address - Street 2:SUITE A
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2007
Practice Address - Country:US
Practice Address - Phone:209-575-4575
Practice Address - Fax:209-529-3260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96546207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A965461OtherINDIVIDUAL MEDICARE NUMBER