Provider Demographics
NPI:1467193631
Name:ZAMUDIO, DANYELA ALYCIA (LMFT, APCC)
Entity Type:Individual
Prefix:
First Name:DANYELA
Middle Name:ALYCIA
Last Name:ZAMUDIO
Suffix:
Gender:F
Credentials:LMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 E GARVEY AVE N STE B17
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-1545
Mailing Address - Country:US
Mailing Address - Phone:626-489-9114
Mailing Address - Fax:
Practice Address - Street 1:2155 E GARVEY AVE N STE B17
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-1545
Practice Address - Country:US
Practice Address - Phone:626-489-9114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-04
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA132795106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist