Healthcare Provider Details

I. General information

NPI: 1659927747
Provider Name (Legal Business Name): ALICIA GUADALUPE ZURITA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 HOWARD RD STE B&C
MADERA CA
93637-5163
US

IV. Provider business mailing address

1915 HOWARD RD STE B&C
MADERA CA
93637-5163
US

V. Phone/Fax

Practice location:
  • Phone: 559-330-2211
  • Fax:
Mailing address:
  • Phone: 559-330-3311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberF6990506
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: