Provider Demographics
NPI:1104564103
Name:PENALOZA, ZAIRA (OTR/L)
Entity type:Individual
Prefix:
First Name:ZAIRA
Middle Name:
Last Name:PENALOZA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3136
Mailing Address - Country:US
Mailing Address - Phone:323-402-3626
Mailing Address - Fax:
Practice Address - Street 1:6701 KOLL CENTER PKWY STE 250
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-8062
Practice Address - Country:US
Practice Address - Phone:925-500-8383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2024-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT23409225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist