Provider Demographics
NPI:1831683234
Name:ZAMORA, MAY CHARLENE QUIRINO
Entity type:Individual
Prefix:
First Name:MAY CHARLENE
Middle Name:QUIRINO
Last Name:ZAMORA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 QUIET HILLS RD
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-4764
Mailing Address - Country:US
Mailing Address - Phone:909-509-0389
Mailing Address - Fax:
Practice Address - Street 1:1520 N MOUNTAIN AVE STE 128
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-1132
Practice Address - Country:US
Practice Address - Phone:909-949-9299
Practice Address - Fax:909-949-9029
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009217363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty