1801160957 NPI number — MARIA BERENICE DEL REAL ZEPEDA

Table of content: MARIA BERENICE DEL REAL ZEPEDA (NPI 1801160957)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801160957 NPI number — MARIA BERENICE DEL REAL ZEPEDA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEL REAL ZEPEDA
Provider First Name:
MARIA
Provider Middle Name:
BERENICE
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:
1801160957
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21732 S VERMONT AVE STE 210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TORRANCE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90502-2180
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-781-3400
Provider Business Mailing Address Fax Number:
310-782-0754

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 W. CARSON ST.
Provider Second Line Business Practice Location Address:
BOX 497
Provider Business Practice Location Address City Name:
TORRANCE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-222-1602
Provider Business Practice Location Address Fax Number:
310-212-7609
Provider Enumeration Date:
03/06/2012

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2025 www.npivalidator.com