Healthcare Provider Details

I. General information

NPI: 1205014149
Provider Name (Legal Business Name): ROSA A ZAZUETA B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 RUFFIN CT
SAN DIEGO CA
92123-5300
US

IV. Provider business mailing address

4438 OREGON ST APT 8
SAN DIEGO CA
92116-6031
US

V. Phone/Fax

Practice location:
  • Phone: 858-514-4867
  • Fax:
Mailing address:
  • Phone: 619-813-4204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: