Provider Demographics
NPI:1356157051
Name:ZAMORA, PRINCESS KRYZTAL ALEXYS
Entity type:Individual
Prefix:
First Name:PRINCESS
Middle Name:KRYZTAL ALEXYS
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 1:7452 W CREST LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-5619
Mailing Address - Country:US
Mailing Address - Phone:831-597-4192
Mailing Address - Fax:
Practice Address - Street 1:7452 W CREST LN
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310-5619
Practice Address - Country:US
Practice Address - Phone:831-597-4192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant