Healthcare Provider Details

I. General information

NPI: 1821762345
Provider Name (Legal Business Name): MONICA AYDEE ZAVALA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2021
Last Update Date: 08/07/2021
Certification Date: 08/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 1ST ST
COACHELLA CA
92236-1407
US

IV. Provider business mailing address

26256 CHESTNUT DR
MORENO VALLEY CA
92555-2244
US

V. Phone/Fax

Practice location:
  • Phone: 760-398-9000
  • Fax:
Mailing address:
  • Phone: 951-796-0192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC8774
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: