1386969798 NPI number — MIUSOTIC ZARAGOZA MSW/ASW

Table of content: MIUSOTIC ZARAGOZA MSW/ASW (NPI 1386969798)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386969798 NPI number — MIUSOTIC ZARAGOZA MSW/ASW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZARAGOZA
Provider First Name:
MIUSOTIC
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW/ASW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386969798
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7525 SHORELINE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STOCKTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95219-4589
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-594-0333
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1755 W. HAMMER LANE SUITE 8
Provider Second Line Business Practice Location Address:
LATINO BEHAVIORAL HEALTH
Provider Business Practice Location Address City Name:
STOCKTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-444-8910
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/30/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 24975 . This is a "ASW" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".