Healthcare Provider Details

I. General information

NPI: 1326839309
Provider Name (Legal Business Name): MERINA IVETTE ZAZUETA-SERRANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2025
Last Update Date: 07/09/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E SAN JACINTO AVE
PERRIS CA
92571-2833
US

IV. Provider business mailing address

12051 HARCLARE DR
MORENO VALLEY CA
92557-7826
US

V. Phone/Fax

Practice location:
  • Phone: 951-210-1480
  • Fax: 951-306-3760
Mailing address:
  • Phone: 951-529-9244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: