Healthcare Provider Details

I. General information

NPI: 1487382149
Provider Name (Legal Business Name): LIDIA MONTERROSO ZELAYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 SUTTER ST
CONCORD CA
94520-2559
US

IV. Provider business mailing address

617 BOUNTY DR
BAY POINT CA
94565-2953
US

V. Phone/Fax

Practice location:
  • Phone: 925-827-2798
  • Fax:
Mailing address:
  • Phone: 925-360-4898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number107669
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: