Healthcare Provider Details

I. General information

NPI: 1801904487
Provider Name (Legal Business Name): MARY ANNE ZAPOR MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 BENTON ST
LOMA LINDA CA
92357-1000
US

IV. Provider business mailing address

1423 ARLENE ST
REDLANDS CA
92374-2045
US

V. Phone/Fax

Practice location:
  • Phone: 909-825-7084
  • Fax: 909-777-3834
Mailing address:
  • Phone: 909-335-1054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 20043
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: