Healthcare Provider Details

I. General information

NPI: 1326890781
Provider Name (Legal Business Name): EMMANUEL ZAVALA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W FLORIDA AVE STE B
HEMET CA
92543-4628
US

IV. Provider business mailing address

790 S STATE ST STE 6
SAN JACINTO CA
92583-4924
US

V. Phone/Fax

Practice location:
  • Phone: 909-520-3309
  • Fax:
Mailing address:
  • Phone: 909-520-3309
  • 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: