Provider Demographics
NPI:1548098866
Name:SEVILLA, ZAIDA LINDA
Entity type:Individual
Prefix:MISS
First Name:ZAIDA
Middle Name:LINDA
Last Name:SEVILLA
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 1:25355 IVORY AVE
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92551-9230
Mailing Address - Country:US
Mailing Address - Phone:951-322-3528
Mailing Address - Fax:
Practice Address - Street 1:3880 LEMON ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3667
Practice Address - Country:US
Practice Address - Phone:951-682-1488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT148047106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist