Healthcare Provider Details

I. General information

NPI: 1770761611
Provider Name (Legal Business Name): RODOLFO ZUNIGA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 E CESAR E CHAVEZ AVE STE 1E
LOS ANGELES CA
90022-1116
US

IV. Provider business mailing address

4545 E CESAR E CHAVEZ AVE STE 1E
LOS ANGELES CA
90022-1116
US

V. Phone/Fax

Practice location:
  • Phone: 323-265-2699
  • Fax: 323-265-4273
Mailing address:
  • Phone: 323-265-2699
  • Fax: 323-265-4273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS22216
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: