Healthcare Provider Details

I. General information

NPI: 1629533948
Provider Name (Legal Business Name): ELIZABETH ZAVALA SILVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2019
Last Update Date: 09/20/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3313 N SONORA AVE
FRESNO CA
93722-4668
US

IV. Provider business mailing address

7109 DANNY DR
STOCKTON CA
95210-5320
US

V. Phone/Fax

Practice location:
  • Phone: 559-549-6619
  • Fax:
Mailing address:
  • Phone: 209-957-7777
  • Fax: 209-473-3344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-75797
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number19-75797
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: