Provider Demographics
NPI:1003037466
Name:ZARAGOZA, ANTOINETTE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:PROF
First Name:ANTOINETTE
Middle Name:
Last Name:ZARAGOZA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MS
Other - First Name:TONI
Other - Middle Name:
Other - Last Name:ZARAGOZA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:245 S. FETTERLY AVE
Mailing Address - Street 2:ROYBAL COMPREHENSIVE CHC
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-0000
Mailing Address - Country:US
Mailing Address - Phone:323-780-2216
Mailing Address - Fax:
Practice Address - Street 1:245 S. FETTERLY AVE
Practice Address - Street 2:ROYBAL COMPREHENSIVE CHC
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-0000
Practice Address - Country:US
Practice Address - Phone:323-780-2216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA266488363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health