Provider Demographics
NPI:1073331302
Name:ZELADITA, VICTOR HUGO (SUDCC IV)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:HUGO
Last Name:ZELADITA
Suffix:
Gender:M
Credentials:SUDCC IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8427 NEVADA AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91304-2332
Mailing Address - Country:US
Mailing Address - Phone:818-674-1041
Mailing Address - Fax:
Practice Address - Street 1:6551 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1566
Practice Address - Country:US
Practice Address - Phone:818-765-8656
Practice Address - Fax:818-765-4548
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAII051990424101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)