Healthcare Provider Details

I. General information

NPI: 1437963964
Provider Name (Legal Business Name): DAVID ZEPEDA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 01/04/2026
Certification Date: 01/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44505 90TH ST W
LANCASTER CA
93536-7705
US

IV. Provider business mailing address

44505 90TH ST W
LANCASTER CA
93536-7705
US

V. Phone/Fax

Practice location:
  • Phone: 626-726-2630
  • Fax:
Mailing address:
  • Phone: 626-726-2630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1570130724
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-VFSUIW
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: