Healthcare Provider Details

I. General information

NPI: 1477839355
Provider Name (Legal Business Name): ZEYDA MARGARITA FERNANDEZ M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2011
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 E FOOTHILL BLVD FL 2
PASADENA CA
91107-3406
US

IV. Provider business mailing address

2123 N COMMONWEALTH AVE
LOS ANGELES CA
90027-2117
US

V. Phone/Fax

Practice location:
  • Phone: 626-802-0909
  • Fax:
Mailing address:
  • Phone: 323-528-5848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMF66381
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAMFT135023
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT135023
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: