Provider Demographics
NPI:1588343875
Name:ZAMUDIO, ADRIAN ALEXANDER
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:ALEXANDER
Last Name:ZAMUDIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16505 VANOWEN ST APT 116
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-4738
Mailing Address - Country:US
Mailing Address - Phone:818-298-3332
Mailing Address - Fax:
Practice Address - Street 1:11631 VICTORY BLVD STE 203
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3572
Practice Address - Country:US
Practice Address - Phone:818-908-3855
Practice Address - Fax:818-753-5265
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner