Healthcare Provider Details

I. General information

NPI: 1982187530
Provider Name (Legal Business Name): ELVA QUETZERI ZAMUDIO-GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 TECHNOLOGY CT STE 105
RIVERSIDE CA
92507-2181
US

IV. Provider business mailing address

17800 WOODRUFF AVE
BELLFLOWER CA
90706-7079
US

V. Phone/Fax

Practice location:
  • Phone: 951-686-8500
  • Fax:
Mailing address:
  • Phone: 562-866-8956
  • Fax: 562-866-4158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: