Provider Demographics
NPI:1073840245
Name:SEPULVEDA, LINDA ZORA
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:ZORA
Last Name:SEPULVEDA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LINDA
Other - Middle Name:ZORA
Other - Last Name:TASSERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:769 W BLAINE ST STE B
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-3970
Mailing Address - Country:US
Mailing Address - Phone:951-358-7662
Mailing Address - Fax:951-358-4594
Practice Address - Street 1:769 W BLAINE ST STE B
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-3970
Practice Address - Country:US
Practice Address - Phone:951-358-7662
Practice Address - Fax:951-358-4594
Is Sole Proprietor?:No
Enumeration Date:2009-11-10
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health