Healthcare Provider Details

I. General information

NPI: 1053789446
Provider Name (Legal Business Name): SUSI GARAY ZECENA RN, BSN, MSN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSI ZECENA ORTIZ

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 S MAIN AVE STE K
FALLBROOK CA
92028-3351
US

IV. Provider business mailing address

855 S MAIN AVE STE K
FALLBROOK CA
92028-3351
US

V. Phone/Fax

Practice location:
  • Phone: 310-701-7624
  • Fax:
Mailing address:
  • Phone: 310-701-7624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95141591
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95031588
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: