Healthcare Provider Details

I. General information

NPI: 1326645797
Provider Name (Legal Business Name): SAMARIA ZEPEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 10/08/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14427 MERIDIAN PKWY STE E
RIVERSIDE CA
92518-3015
US

IV. Provider business mailing address

2080 N TUSTIN AVE STE B
SANTA ANA CA
92705-7875
US

V. Phone/Fax

Practice location:
  • Phone: 855-581-0100
  • Fax:
Mailing address:
  • Phone: 855-581-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: