Healthcare Provider Details

I. General information

NPI: 1689315228
Provider Name (Legal Business Name): JULIANNA LILLIAN ZEPEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3255 OLD CONEJO RD STE 202
NEWBURY PARK CA
91320-2153
US

IV. Provider business mailing address

237 FRASER LN
VENTURA CA
93001-1107
US

V. Phone/Fax

Practice location:
  • Phone: 805-254-6249
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: