Healthcare Provider Details

I. General information

NPI: 1952823205
Provider Name (Legal Business Name): ROSIO ZARAGOZA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 11/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58945 BUSINESS CENTER DR STE D
YUCCA VALLEY CA
92284-7310
US

IV. Provider business mailing address

81291 GREEN AVE
INDIO CA
92201-5334
US

V. Phone/Fax

Practice location:
  • Phone: 760-228-9657
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberACW80039
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: