Healthcare Provider Details

I. General information

NPI: 1275935710
Provider Name (Legal Business Name): JANISE ZAYAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 11/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 W METROPOLITAN DR
ORANGE CA
92868-3504
US

IV. Provider business mailing address

25562 GLORIOSA DR
MISSION VIEJO CA
92691-4644
US

V. Phone/Fax

Practice location:
  • Phone: 714-935-6117
  • Fax:
Mailing address:
  • Phone: 408-390-2278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number88199
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: