Provider Demographics
NPI:1710728654
Name:ZOTOS, ANNIE (SLP)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:ZOTOS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:BOX 919
Mailing Address - Street 2:4712 2ND STREET
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803
Mailing Address - Country:US
Mailing Address - Phone:415-712-2267
Mailing Address - Fax:
Practice Address - Street 1:12443 LEWIS ST STE 201
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-4650
Practice Address - Country:US
Practice Address - Phone:714-748-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician