Healthcare Provider Details

I. General information

NPI: 1851115323
Provider Name (Legal Business Name): KIMBERLY NICOLE ZUNIGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 S GRAND AVE
LOS ANGELES CA
90007-4331
US

IV. Provider business mailing address

278 FOXBURY AVE
POMONA CA
91767-1420
US

V. Phone/Fax

Practice location:
  • Phone: 213-308-6637
  • Fax:
Mailing address:
  • Phone: 970-589-7304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: