Provider Demographics
NPI:1336278472
Name:ZUNIGA, MARTHA ELSA
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ELSA
Last Name:ZUNIGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 JUSTINE CT
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-2356
Mailing Address - Country:US
Mailing Address - Phone:626-810-2874
Mailing Address - Fax:626-810-7010
Practice Address - Street 1:8207 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-2521
Practice Address - Country:US
Practice Address - Phone:562-695-0737
Practice Address - Fax:562-695-0413
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARS8873101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARS8873OtherREGISTRATION