Healthcare Provider Details

I. General information

NPI: 1689226904
Provider Name (Legal Business Name): QUEENE CARLA OABEL ZAPORTEZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E MAIN ST STE 201
GRASS VALLEY CA
95945-5853
US

IV. Provider business mailing address

142 RADCLIFFE DR
VALLEJO CA
94589-1818
US

V. Phone/Fax

Practice location:
  • Phone: 530-273-2244
  • Fax:
Mailing address:
  • Phone: 707-853-7189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number995840
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number121216
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: