Healthcare Provider Details

I. General information

NPI: 1902273774
Provider Name (Legal Business Name): YESENIA ZAVALA M.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2015
Last Update Date: 08/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 GIANOLINI PKWY
GREENFIELD CA
93927-5557
US

IV. Provider business mailing address

42 GIANOLINI PKWY
GREENFIELD CA
93927-5557
US

V. Phone/Fax

Practice location:
  • Phone: 831-776-1564
  • Fax:
Mailing address:
  • Phone: 831-776-1564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: