Healthcare Provider Details

I. General information

NPI: 1609160175
Provider Name (Legal Business Name): LILY JUDITH ZUMAETA MS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2011
Last Update Date: 06/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N MAIN ST
SANTA ANA CA
92701-2321
US

IV. Provider business mailing address

708 S 7TH ST
ALHAMBRA CA
91801-4629
US

V. Phone/Fax

Practice location:
  • Phone: 714-222-4400
  • Fax:
Mailing address:
  • Phone: 626-203-7234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number991302
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: