KELLY R ZOLLO (NPI# 1962638510) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962638510 |
| Entity Type | Individual |
| Full Name | KELLY R ZOLLO |
| Credential | LPT |
| Practice Address |
12353 Imperial Hwy Norwalk CA 90650-8305 |
| Practice Telephone | 5624843385 |
| Practice Fax Number | 5624840269 |
| Mailing Telephone | 5624843385 |
| Mailing Fax Number | 5624840269 |
| Enumeration Date | 2009-06-09 |
| Last Update Date | 2009-06-09 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 167G00000X | Licensed Psychiatric Technician | 30755 | CA | Nursing Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 1512013461 | 05 |
| Street Address |
12353 IMPERIAL HWY |
| City | NORWALK |
| State | CA |
| Zip Code | 90650-8305 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477639946 | David Adolfo Coloma | Licensed Psychiatric Technician | 12353 Imperial Hwy, Apt. #1, Norwalk, CA 90650 | 2006-10-27 |
| 1649554486 | Martin Mario Ginger | Counselor | 12353 Imperial Hwy, Norwalk, CA 90650-8305 | 2011-09-28 |
| 1174822027 | Jeffrey Lynne Travers | Case Manager/Care Coordinator | 12353 Imperial Hwy, Norwalk, CA 90650-8305 | 2011-03-17 |
| 1013230929 | Tat Wong | Counselor | 12353 Imperial Hwy, Norwalk, CA 90650-8305 | 2010-03-05 |
| 1023342698 | Christy Perry | Counselor | 12353 Imperial Hwy, Norwalk, CA 90650-8305 | 2009-09-29 |
| 1154554319 | Carlos Marquez | Licensed Vocational Nurse | 12353 Imperial Hwy, Norwalk, CA 90650-8305 | 2009-09-03 |
| 1326209651 | Marcie Gomez | Licensed Vocational Nurse | 12353 Imperial Hwy, Norwalk, CA 90650-8305 | 2008-06-19 |
| 1528240231 | Aloah Dawn Byrum | Counselor | 12353 Imperial Hwy, Norwalk, CA 90650-8305 | 2007-12-04 |
| 1598814451 | Oleina M Brown | Counselor | 12353 Imperial Hwy, Norwalk, CA 90650-8305 | 2007-01-09 |
| 1760540991 | Charles Frederick Stone | Psychiatry & Neurology | 12353 Imperial Hwy, Norwalk, CA 90650-8305 | 2006-12-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003420316 | Ricky Chavez | Occupational Therapist | 13603 Halcourt Avenue, Norwalk, CA 90650 | 2020-09-03 |
| 1326671652 | Ryan Ly | Psychologist | 11400 Bloomfield Blvd, Norwalk, CA 90650 | 2020-02-14 |
| 1710416177 | Ricky O Lee | Pharmacist | 11401 S. Bloomfield Ave, Norwalk, CA 90650 | 2017-06-08 |
| 1689108847 | Eliana Segura | Student in an Organized Health Care Education/Training Program | 12440 Firestone Ave Blvd., 3020, Norwalk, CA 90650 | 2017-04-14 |
| 1396282752 | Martin Sanchez Torres | Specialist/Technologist, Other | 14003 Summer Ave, Norwalk, CA 90650 | 2017-01-24 |
| 1952859837 | Fatimah Busran | Social Worker | 11401 South Bloomfield Avde., Norwalk, CA 90650 | 2016-09-20 |
| 1760939383 | Andy Chang | Licensed Psychiatric Technician | 12440 East Imperial Highway, Suite 116, Norwalk, CA 90650 | 2016-09-01 |
| 1548634322 | Leslie Yesenia Lazo | Student in an Organized Health Care Education/Training Program | 12440 E. Firestone Blvd, Norwalk, CA 90650 | 2015-11-17 |
| 1306247994 | Ruth Vergara | Student in an Organized Health Care Education/Training Program | 21520 S. Pioneer Blvd., Suite 110, Hawaiian Gardens, CA 90650 | 2014-09-15 |
| 1265854251 | Sungmin Yee | Acupuncturist | 12706 Bloomfield Ave, Apt. 135, Norwalk, CA 90650 | 2014-01-10 |
| Find all providers in zip 90650 | ||||
| Taxonomy Code | 167G00000X |
| Grouping | Nursing Service Providers |
| Classification | Licensed Psychiatric Technician |
| An individual licensed by the state board as a Psychiatric Technician based upon completion of a prescribed course of theory and clinical practice, with two thirds of the clinical practice time focused on mental and developmental disorders. The psychiatric technician practices under the direct supervision of a physician, psychologist, registered nurse or other professional to provide care to patients with mental disorders and developmental disabilities. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902438070 | Erik Anthony Paniagua | Licensed Psychiatric Technician | 12906 Indian Ln, Norwalk, CA 90650-3313 | 2020-02-06 |
| 1760939383 | Andy Chang | Licensed Psychiatric Technician | 12440 East Imperial Highway, Suite 116, Norwalk, CA 90650 | 2016-09-01 |
| 1861857419 | Bruce Niels | Licensed Psychiatric Technician | 12440 East Norwalk Boulevard, Suite 3020, Norwalk, CA 90650-9331 | 2015-12-28 |
| 1376767020 | Rick Bottoms | Licensed Psychiatric Technician | 12240 Firestone Blvd, Suite 3020, Norwalk, CA 90650 | 2007-04-12 |
| 1710052774 | Dawnell J Prescott | Licensed Psychiatric Technician | 12353 E Imperial, Norwalk, CA 90650 | 2006-11-22 |
| 1477639946 | David Adolfo Coloma | Licensed Psychiatric Technician | 12353 Imperial Hwy, Apt. #1, Norwalk, CA 90650 | 2006-10-27 |
| 1639776495 | Camille Williams | Licensed Psychiatric Technician | 12440 Firestone Blvd Ste 3015, Norwalk, CA 90650-9333 | 2020-10-05 |
| 1871110379 | Veronica Lizett Soni | Licensed Psychiatric Technician | 12440 Firestone Blvd Ste 3020, Norwalk, CA 90650-9328 | 2020-06-30 |
| 1003432436 | Cynthia M Torres | Licensed Psychiatric Technician | 12440 Firestone Blvd Ste 3020, Norwalk, CA 90650-9328 | 2020-06-22 |
| 1316574247 | Maryam Booth | Licensed Psychiatric Technician | 12440 Firestone Blvd Ste 3020, Norwalk, CA 90650-9328 | 2020-03-23 |
| Find all providers in NORWALK | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.