Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 20A1063 | CA |
N | 207QA0505X | Family Doctor - Adult Medicine | 20A1063 | CA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 20A1063 | CA |
NPI | 1043482060 |
---|---|
Provider Name | Dr. Antonio Zamorano |
First Address | Glendale, CA 91205-2866 |
Second Address | Glendale, CA 91205-2866 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2008 |
Last Update Date | 05/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1346557691 | (05) | CA |