Healthcare Provider Details

I. General information

NPI: 1649795824
Provider Name (Legal Business Name): THELMA MELISSA MORA ZAZUETA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8110 POCKET RD STE 102
SACRAMENTO CA
95831-5829
US

IV. Provider business mailing address

2475 PASEO DE LAS AMERICAS # 3826
SAN DIEGO CA
92154-7255
US

V. Phone/Fax

Practice location:
  • Phone: 916-245-0715
  • Fax:
Mailing address:
  • Phone: 425-577-0130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number141793
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: