Healthcare Provider Details

I. General information

NPI: 1134808512
Provider Name (Legal Business Name): AMELIA LUCIA ZAPATA SUDRC 15309
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W MANCHESTER BLVD STE A
INGLEWOOD CA
90301-1196
US

IV. Provider business mailing address

405 W MANCHESTER BLVD STE A
INGLEWOOD CA
90301-1196
US

V. Phone/Fax

Practice location:
  • Phone: 310-672-3820
  • Fax: 310-672-3822
Mailing address:
  • Phone: 310-672-3820
  • Fax: 310-672-3822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number14599
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: