Healthcare Provider Details

I. General information

NPI: 1245548932
Provider Name (Legal Business Name): SEPIDEH ZAHEDY- KAPUSTA,MD,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2094 W LA HABRA BLVD
LA HABRA CA
90631-5007
US

IV. Provider business mailing address

2094 W LA HABRA BLVD
LA HABRA CA
90631-5007
US

V. Phone/Fax

Practice location:
  • Phone: 562-697-1001
  • Fax: 562-696-1003
Mailing address:
  • Phone: 562-697-1001
  • Fax: 562-696-1003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA99099
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207VC0200X
TaxonomyCritical Care Medicine (Obstetrics & Gynecology) Physician
License NumberA99099
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberA99099
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberA99099
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA99099
License Number StateCA

VIII. Authorized Official

Name: THERESA GARCIA
Title or Position: MANAGER
Credential:
Phone: 562-697-1001