Provider Demographics
NPI:1801160957
Name:DEL REAL ZEPEDA, MARIA BERENICE
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:BERENICE
Last Name:DEL REAL ZEPEDA
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 1:21732 S VERMONT AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2180
Mailing Address - Country:US
Mailing Address - Phone:310-781-3400
Mailing Address - Fax:310-782-0754
Practice Address - Street 1:1000 W. CARSON ST.
Practice Address - Street 2:BOX 497
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90509
Practice Address - Country:US
Practice Address - Phone:310-222-1602
Practice Address - Fax:310-212-7609
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner