MEDICARE: RODOLFO ZUNIGA LCSW

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	1041C0700X	Clinical Social Worker	LCS22216	CA

General Provider Information

NPI Number	:	1770761611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RODOLFO ZUNIGA LCSW

Provider Business Mailing Address
First Line	:	4545 E CESAR E CHAVEZ AVE STE 1E
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-1116
Country	:	US
Telephone Number	:	323-265-2699
Fax Number	:	323-265-4273

Provider Business Practice Location Address
First Line	:	4545 E CESAR E CHAVEZ AVE STE 1E
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-1116
Country	:	US
Telephone Number	:	323-265-2699
Fax Number	:	323-265-4273

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

Provider Enumeration Date	:	02/01/2008
Last Update Date	:	02/21/2008

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