Healthcare Provider Details

I. General information

NPI: 1881330918
Provider Name (Legal Business Name): ZOCALO MEDICAL GROUP CA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 E WALNUT ST
SANTA ANA CA
92701-5896
US

IV. Provider business mailing address

214 E WALNUT ST
SANTA ANA CA
92701-5896
US

V. Phone/Fax

Practice location:
  • Phone: 213-855-3465
  • Fax: 833-871-4204
Mailing address:
  • Phone: 213-855-3465
  • Fax: 833-871-4204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIZA HARDIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 505-280-5669