Provider Demographics
NPI:1902470495
Name:AMEZAGA, ZENORINA L
Entity Type:Individual
Prefix:
First Name:ZENORINA
Middle Name:L
Last Name:AMEZAGA
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 1:1462 S PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-1733
Mailing Address - Country:US
Mailing Address - Phone:928-783-6575
Mailing Address - Fax:928-783-6728
Practice Address - Street 1:1462 S PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-1733
Practice Address - Country:US
Practice Address - Phone:928-783-6575
Practice Address - Fax:928-783-6728
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZT034976183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician