Provider Demographics
NPI:1447063367
Name:ZAMORA CAMARENA, JUAN CARLOS (DENTIST)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:CARLOS
Last Name:ZAMORA CAMARENA
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2489 BURLINGHAM PL
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-2325
Mailing Address - Country:US
Mailing Address - Phone:805-387-8452
Mailing Address - Fax:
Practice Address - Street 1:2150 N ROSE AVE
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-5058
Practice Address - Country:US
Practice Address - Phone:805-253-2958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1111841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice