Healthcare Provider Details

I. General information

NPI: 1164300489
Provider Name (Legal Business Name): SALLY ZAMUDIO GONZALEZ PPS, ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 IOWA ST
FALLBROOK CA
92028-2108
US

IV. Provider business mailing address

321 IOWA ST
FALLBROOK CA
92028-2108
US

V. Phone/Fax

Practice location:
  • Phone: 760-731-5423
  • Fax:
Mailing address:
  • Phone: 760-731-5423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number220183616
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: