Healthcare Provider Details

I. General information

NPI: 1053955898
Provider Name (Legal Business Name): CATHLEEN ZEPEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2019
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9890 COUNTY FARM RD BUILDING 2
RIVERSIDE CA
92503
US

IV. Provider business mailing address

9825 MAGNOLIA AVE. SUITE B, PMB 322
RIVERSIDE CA
92503
US

V. Phone/Fax

Practice location:
  • Phone: 951-509-2499
  • Fax:
Mailing address:
  • Phone: 951-509-2499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number248787
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: