Healthcare Provider Details

I. General information

NPI: 1770614752
Provider Name (Legal Business Name): ZONIA KAREN MIJANGOS ALONSO MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12021 WILMINGTON AVE
LOS ANGELES CA
90059-3019
US

IV. Provider business mailing address

12021 WILMINGTON AVE
LOS ANGELES CA
90059-3019
US

V. Phone/Fax

Practice location:
  • Phone: 213-305-4080
  • Fax:
Mailing address:
  • Phone: 213-305-4080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number48442
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: