Healthcare Provider Details

I. General information

NPI: 1477214807
Provider Name (Legal Business Name): CARMELA ZARAGOZA PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2022
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12713 DILWORTH ST
NORWALK CA
90650-4433
US

IV. Provider business mailing address

12713 DILWORTH ST
NORWALK CA
90650-4433
US

V. Phone/Fax

Practice location:
  • Phone: 310-801-2214
  • Fax:
Mailing address:
  • Phone: 310-801-2214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number753129
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95021672
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: