Provider Demographics
NPI:1982335899
Name:ZAZUETA, CLARISSA R
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:R
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 1:7108 S KANNER HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7462
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:539 N VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93728-3419
Practice Address - Country:US
Practice Address - Phone:559-266-9581
Practice Address - Fax:559-498-7050
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
CA15452101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other