Provider Demographics
NPI:1891280962
Name:ZAZUETA, SUSAN GUADALUPE
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:GUADALUPE
Last Name:ZAZUETA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12227 OSBORNE PL APT 129
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-7033
Mailing Address - Country:US
Mailing Address - Phone:818-268-0105
Mailing Address - Fax:
Practice Address - Street 1:12227 OSBORNE PL APT 129
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-7033
Practice Address - Country:US
Practice Address - Phone:818-268-0105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator