Healthcare Provider Details

I. General information

NPI: 1326170309
Provider Name (Legal Business Name): TIMOTHY RAYMOND ZAVALA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 SIERRA ST STE 300
KINGSBURG CA
93631-1547
US

IV. Provider business mailing address

1340 SIERRA ST STE 300
KINGSBURG CA
93631-1547
US

V. Phone/Fax

Practice location:
  • Phone: 559-691-0818
  • Fax:
Mailing address:
  • Phone: 559-691-0818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 21305
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: