Healthcare Provider Details

I. General information

NPI: 1487512489
Provider Name (Legal Business Name): SALLY HERNANDEZ ZARATE SUDCC II
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2026
Last Update Date: 01/10/2026
Certification Date: 01/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15372 MICHAEL ST
TAYLOR MI
48180-5015
US

IV. Provider business mailing address

15372 MICHAEL ST
TAYLOR MI
48180-5015
US

V. Phone/Fax

Practice location:
  • Phone: 562-317-8858
  • Fax:
Mailing address:
  • Phone: 562-322-0046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: