Healthcare Provider Details

I. General information

NPI: 1326709627
Provider Name (Legal Business Name): BEA ZERGIELLANE DAVID JAIME-LY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2022
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7765 LEEDS ST
DOWNEY CA
90242-3489
US

IV. Provider business mailing address

14619 LA FONDA DR
LA MIRADA CA
90638-4021
US

V. Phone/Fax

Practice location:
  • Phone: 858-336-3081
  • Fax:
Mailing address:
  • Phone: 714-624-6401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95071652
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: