Healthcare Provider Details

I. General information

NPI: 1205672425
Provider Name (Legal Business Name): DIANA ZURITA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 07/08/2024
Certification Date: 07/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1933 S BROADWAY OFC 6TH
LOS ANGELES CA
90007-4501
US

IV. Provider business mailing address

PO BOX 60835
LOS ANGELES CA
90060-0835
US

V. Phone/Fax

Practice location:
  • Phone: 213-763-3160
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: