Healthcare Provider Details

I. General information

NPI: 1043186604
Provider Name (Legal Business Name): KELLY ZAVALA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 CHURCH AVE STE 3
CHULA VISTA CA
91910-2718
US

IV. Provider business mailing address

5371 TOPSAIL DR
SAN DIEGO CA
92154-8589
US

V. Phone/Fax

Practice location:
  • Phone: 619-737-2989
  • Fax: 619-737-2998
Mailing address:
  • Phone: 951-816-2854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW134319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: