Healthcare Provider Details

I. General information

NPI: 1205565736
Provider Name (Legal Business Name): EDITH LILY ZUNIGA-ALDRETE CLINICAL CASE MANAGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5473 KEARNY VILLA RD
SAN DIEGO CA
92123-1150
US

IV. Provider business mailing address

5473 KEARNY VILLA RD STE 300218
SAN DIEGO CA
92123-1150
US

V. Phone/Fax

Practice location:
  • Phone: 619-737-2639
  • Fax: 619-684-7002
Mailing address:
  • Phone: 619-737-2639
  • Fax: 619-684-7002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number13186
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: