Healthcare Provider Details

I. General information

NPI: 1558237206
Provider Name (Legal Business Name): ELIGIO PAUL ZARAGOZA LEP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2025
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43020 BLACK DEER LOOP STE 102
TEMECULA CA
92590-3406
US

IV. Provider business mailing address

4209 CHARLTON AVE
HEMET CA
92544-1869
US

V. Phone/Fax

Practice location:
  • Phone: 619-632-7079
  • Fax:
Mailing address:
  • Phone: 951-376-8007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4645
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: