Basic Information
| Provider Information | |||||||||
| NPI: | 1801160957 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEL REAL ZEPEDA | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | BERENICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21732 S VERMONT AVE STE 210 | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905022180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107813400 | ||||||||
| FaxNumber: | 3107820754 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 W. CARSON ST. | ||||||||
| Address2: | BOX 497 | ||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102221602 | ||||||||
| FaxNumber: | 3102127609 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2012 | ||||||||
| LastUpdateDate: | 03/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator | 225400000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.