MEDICARE: ALYSSA MARICELA ZEPEDA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	167G00000X	Licensed Psychiatric Technician	40031	CA

General Provider Information

NPI Number	:	1689037897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA MARICELA ZEPEDA

Provider Business Mailing Address
First Line	:	9966 HEMLOCK AVE
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92335-6251
Country	:	US
Telephone Number	:	909-642-8489
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 N PEPPER AVE
Second Line	:
City	:	COLTON
State	:	CA
Zip	:	92324-1819
Country	:	US
Telephone Number	:	909-580-1800
Fax Number	:	909-580-1800

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2016
Last Update Date	:	01/16/2026

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