Healthcare Provider Details

I. General information

NPI: 1891837175
Provider Name (Legal Business Name): SAUL ZEPEDA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S DE LACEY AVE SUITE 110
PASADENA CA
91105-2048
US

IV. Provider business mailing address

15222 CARMELITA AVE
CHINO HILLS CA
91709-3788
US

V. Phone/Fax

Practice location:
  • Phone: 626-395-7100
  • Fax:
Mailing address:
  • Phone: 323-829-3252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW 61427
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: