Healthcare Provider Details

I. General information

NPI: 1912640327
Provider Name (Legal Business Name): MARTIN ZUNIGA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23461 S POINTE DR STE 220
LAGUNA HILLS CA
92653-1523
US

IV. Provider business mailing address

23461 S POINTE DR STE 220
LAGUNA HILLS CA
92653-1523
US

V. Phone/Fax

Practice location:
  • Phone: 949-855-1556
  • Fax: 949-951-2871
Mailing address:
  • Phone: 949-855-1556
  • Fax: 949-951-2871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: