Provider Demographics
NPI:1255940847
Name:ZARAGOZA, DORIAN (ASW97445)
Entity type:Individual
Prefix:
First Name:DORIAN
Middle Name:
Last Name:ZARAGOZA
Suffix:
Gender:M
Credentials:ASW97445
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 S EASTERN AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90040-2964
Mailing Address - Country:US
Mailing Address - Phone:626-272-9475
Mailing Address - Fax:
Practice Address - Street 1:5100 S EASTERN AVE STE 110
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-2964
Practice Address - Country:US
Practice Address - Phone:626-272-9475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA97445104100000X
CAASW97445101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty