Provider Demographics
NPI:1538911722
Name:RODRIGUEZ ZAZUETA, ZAZDELI GUADALUPE
Entity type:Individual
Prefix:
First Name:ZAZDELI
Middle Name:GUADALUPE
Last Name:RODRIGUEZ 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 1:1097 W WILSON ST
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91768-2951
Mailing Address - Country:US
Mailing Address - Phone:909-242-4342
Mailing Address - Fax:
Practice Address - Street 1:221 N SAN DIMAS AVE # 219
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2664
Practice Address - Country:US
Practice Address - Phone:951-961-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26265225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist