MEDICARE: DIANA ZAVALETA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1285590968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA ZAVALETA

Provider Business Mailing Address
First Line	:	231 W 23RD ST APT 1F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-2160
Country	:	US
Telephone Number	:	708-698-0168
Fax Number	:

Provider Business Practice Location Address
First Line	:	1622 S BLUE ISLAND AVE STE 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-2238
Country	:	US
Telephone Number	:	312-584-0559
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2025
Last Update Date	:	12/26/2025

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Directions to “ DIANA ZAVALETA ” Practice Location

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