Provider Demographics
NPI:1619349313
Name:ZARAGOZA, SAMANTHA (MS)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:ZARAGOZA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:SAHEDA
Other - Middle Name:SAMANTHA
Other - Last Name:ZARAGOZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:1850 SAN BENITO ST
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-4899
Mailing Address - Country:US
Mailing Address - Phone:831-636-2121
Mailing Address - Fax:831-635-0318
Practice Address - Street 1:1850 SAN BENITO ST
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-4899
Practice Address - Country:US
Practice Address - Phone:831-636-2121
Practice Address - Fax:831-635-0318
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69375106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist