Basic Information
| Provider Information | |||||||||
| NPI: | 1417207473 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZEPEDA | ||||||||
| FirstName: | HUMBERTO | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
| NamePrefix: | |||||||||
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| Credential: | CASE MANAGER I | ||||||||
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| Mailing Information | |||||||||
| Address1: | 216 W PUTNAM AVE | ||||||||
| Address2: | |||||||||
| City: | PORTERVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932573472 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5597840312 | ||||||||
| FaxNumber: | 5597845827 | ||||||||
| Practice Location | |||||||||
| Address1: | 216 W PUTNAM AVE | ||||||||
| Address2: | |||||||||
| City: | PORTERVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932573472 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5597840312 | ||||||||
| FaxNumber: | 5597845827 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2012 | ||||||||
| LastUpdateDate: | 09/17/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.