1033651518 NPI number — SILVIA KARINA ZEPEDA-MOLINA

Table of content: SILVIA KARINA ZEPEDA-MOLINA (NPI 1033651518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033651518 NPI number — SILVIA KARINA ZEPEDA-MOLINA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZEPEDA-MOLINA
Provider First Name:
SILVIA
Provider Middle Name:
KARINA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1033651518
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
824 VINEYARD CREEK DR
Provider Second Line Business Mailing Address:
APT 179
Provider Business Mailing Address City Name:
SANTA ROSA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95403-9006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-620-3295
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19270 SONOMA HIGHWAY 12
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SONOMA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95476-5414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-939-6070
Provider Business Practice Location Address Fax Number:
707-939-2272
Provider Enumeration Date:
11/15/2016

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: 124Q00000X , with the licence number:  RDH 20834 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1770669715 . This is a "MEDI-CAL FQHC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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