Provider Demographics
NPI:1578392023
Name:ZUNIGA, ANISSA RENEE
Entity type:Individual
Prefix:
First Name:ANISSA
Middle Name:RENEE
Last Name:ZUNIGA
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 1:2302 W BRIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-3509
Mailing Address - Country:US
Mailing Address - Phone:760-907-9457
Mailing Address - Fax:
Practice Address - Street 1:2302 W BRIGHTON AVE
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-3509
Practice Address - Country:US
Practice Address - Phone:760-907-9457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst