Healthcare Provider Details

I. General information

NPI: 1073331302
Provider Name (Legal Business Name): VICTOR HUGO ZELADITA SUDCC IV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 E COMPTON BLVD
COMPTON CA
90221-3303
US

IV. Provider business mailing address

8427 NEVADA AVE
WEST HILLS CA
91304-2332
US

V. Phone/Fax

Practice location:
  • Phone: 310-668-6800
  • Fax: 424-271-9176
Mailing address:
  • Phone: 818-674-1041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAII051990424
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: