Provider Demographics
NPI:1689321523
Name:ZUNIGA, JOHNNY III
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:
Last Name:ZUNIGA
Suffix:III
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 1:701 ASTER ST
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-2960
Mailing Address - Country:US
Mailing Address - Phone:805-407-8797
Mailing Address - Fax:
Practice Address - Street 1:811 W TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-5400
Practice Address - Country:US
Practice Address - Phone:805-805-2654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA565850154320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness