Provider Demographics
NPI:1770069585
Name:ZAMORA, BRENDA LYNN (NP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:LYNN
Last Name:ZAMORA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:BRENDA
Other - Middle Name:LYNN
Other - Last Name:SHUGRUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16901 CALAHAN ST
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91343-3504
Mailing Address - Country:US
Mailing Address - Phone:360-325-6360
Mailing Address - Fax:
Practice Address - Street 1:1220 E AVENUE S STE D
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-6196
Practice Address - Country:US
Practice Address - Phone:661-947-4124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-15
Last Update Date:2018-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7656363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily