Healthcare Provider Details

I. General information

NPI: 1013646975
Provider Name (Legal Business Name): MISS JANELLE ILEANA ZAVALA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 N STATE ST
HEMET CA
92543-2960
US

IV. Provider business mailing address

650 N STATE ST
HEMET CA
92543-2960
US

V. Phone/Fax

Practice location:
  • Phone: 951-791-3300
  • Fax:
Mailing address:
  • Phone: 951-791-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN724362
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: