Provider Demographics
NPI:1477214807
Name:ZARAGOZA, CARMELA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:CARMELA
Middle Name:
Last Name:ZARAGOZA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12713 DILWORTH ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-4433
Mailing Address - Country:US
Mailing Address - Phone:310-801-2214
Mailing Address - Fax:
Practice Address - Street 1:12713 DILWORTH ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4433
Practice Address - Country:US
Practice Address - Phone:310-801-2214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-07
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA753129163WP0809X
CA95021672363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95021672OtherPMHNP