Basic Information
| Provider Information | |||||||||
| NPI: | 1619114691 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZAMORA | ||||||||
| FirstName: | JESS | ||||||||
| MiddleName: | ALEXANDER | ||||||||
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| Credential: | A.S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3670 MCCALL AVE | ||||||||
| Address2: | APT. 114 | ||||||||
| City: | SELMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936624170 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5598190913 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3636 N 1ST ST | ||||||||
| Address2: | SUITE 135 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937266800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592251464 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2009 | ||||||||
| LastUpdateDate: | 03/16/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | R1204380615 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.