Basic Information
| Provider Information | |||||||||
| NPI: | 1902937048 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZAMUDIO | ||||||||
| FirstName: | MARTHA | ||||||||
| MiddleName: | GONTES | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | IV | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1534 E 220TH ST | ||||||||
| Address2: | |||||||||
| City: | CARSON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907452439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232579600 | ||||||||
| FaxNumber: | 3232578116 | ||||||||
| Practice Location | |||||||||
| Address1: | 840 N AVENUE 66 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900421508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232579600 | ||||||||
| FaxNumber: | 3232578116 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 225400000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.