Provider Demographics
NPI:1053789446
Name:GARAY ZECENA, SUSI (RN, BSN, MSN, PMHNP)
Entity type:Individual
Prefix:
First Name:SUSI
Middle Name:
Last Name:GARAY ZECENA
Suffix:
Gender:F
Credentials:RN, BSN, MSN, PMHNP
Other - Prefix:
Other - First Name:SUSI
Other - Middle Name:
Other - Last Name:ZECENA ORTIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9995 CARMEL MOUNTAIN RD STE B10-11
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2889
Mailing Address - Country:US
Mailing Address - Phone:844-200-2426
Mailing Address - Fax:
Practice Address - Street 1:15929 GARD AVE APT 27
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-6975
Practice Address - Country:US
Practice Address - Phone:310-409-8845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-02
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95141591163WP0808X, 163WP0809X
CA95031588363LP0808X
CA36940167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No167G00000XNursing Service ProvidersLicensed Psychiatric Technician