Provider Demographics
NPI:1043482060
Name:ZAMORANO, ANTONIO (DO)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:
Last Name:ZAMORANO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 S GLENDALE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-2866
Mailing Address - Country:US
Mailing Address - Phone:818-850-5667
Mailing Address - Fax:818-839-2303
Practice Address - Street 1:1030 S GLENDALE AVE STE 200
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-2866
Practice Address - Country:US
Practice Address - Phone:818-850-5667
Practice Address - Fax:818-839-2303
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A1063207QA0000X, 207QA0505X, 207QG0300X, 208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1346557691Medicaid