MEDICARE: VICTOR HUGO ZELADITA SUDCC IV

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	AII051990424	CA
2	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1073331302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTOR HUGO ZELADITA SUDCC IV

Provider Business Mailing Address
First Line	:	8427 NEVADA AVE
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91304-2332
Country	:	US
Telephone Number	:	818-674-1041
Fax Number	:

Provider Business Practice Location Address
First Line	:	921 E COMPTON BLVD
Second Line	:
City	:	COMPTON
State	:	CA
Zip	:	90221-3303
Country	:	US
Telephone Number	:	310-668-6800
Fax Number	:	424-271-9176

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2024
Last Update Date	:	02/03/2026

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