Healthcare Provider Details

I. General information

NPI: 1538385711
Provider Name (Legal Business Name): MS. TAMMY ZAVALA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W HOSPITAL ROAD
FRENCH CAMP CA
95231
US

IV. Provider business mailing address

1542 WALL ST
TRACY CA
95376-3027
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-6208
  • Fax: 209-468-7032
Mailing address:
  • Phone: 209-470-7239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: