Provider Demographics
NPI:1811149354
Name:HENRIQUEZ, ZOILA C
Entity type:Individual
Prefix:MRS
First Name:ZOILA
Middle Name:C
Last Name:HENRIQUEZ
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 1:12099 W WASHINGTON BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-2622
Mailing Address - Country:US
Mailing Address - Phone:310-751-1171
Mailing Address - Fax:310-313-7652
Practice Address - Street 1:12099 W WASHINGTON BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-2622
Practice Address - Country:US
Practice Address - Phone:310-751-1171
Practice Address - Fax:310-313-7652
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC022849OtherDEPARTMENT OF MENTAL HEALTH LOS ANGELES