Provider Demographics
NPI:1558046177
Name:ZENDEJAS, RAUL
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:ZENDEJAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 FIRST ST
Mailing Address - Street 2:
Mailing Address - City:COACHELLA
Mailing Address - State:CA
Mailing Address - Zip Code:92236
Mailing Address - Country:US
Mailing Address - Phone:909-725-9583
Mailing Address - Fax:
Practice Address - Street 1:50173 CALLE MARBELLA
Practice Address - Street 2:
Practice Address - City:COACHELLA
Practice Address - State:CA
Practice Address - Zip Code:92236-5542
Practice Address - Country:US
Practice Address - Phone:909-725-9583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13792101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)