Basic Information
| Provider Information | |||||||||
| NPI: | 1013260678 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MENDOZA ZUNIGA | ||||||||
| FirstName: | MARICELA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 621 LANTANA ST APT 30 | ||||||||
| Address2: | |||||||||
| City: | CAMARILLO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930106133 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3105 WILSON RD | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933045319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613978775 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2012 | ||||||||
| LastUpdateDate: | 04/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 97683 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.