Healthcare Provider Details

I. General information

NPI: 1306508759
Provider Name (Legal Business Name): ZAYRA TAYAHUA-VALDIVIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 N CORNELIA AVE
FRESNO CA
93722-7020
US

IV. Provider business mailing address

311 E MERCED ST
FOWLER CA
93625-2316
US

V. Phone/Fax

Practice location:
  • Phone: 559-274-4700
  • Fax:
Mailing address:
  • Phone: 559-892-9452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: