Healthcare Provider Details

I. General information

NPI: 1407589872
Provider Name (Legal Business Name): MR. ZACHARY M CAYABAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 LONG BEACH BLVD STE 7EACH
LONG BEACH CA
90807-2011
US

IV. Provider business mailing address

4499 VIA MARISOL APT 113
LOS ANGELES CA
90042-5129
US

V. Phone/Fax

Practice location:
  • Phone: 562-595-8111
  • Fax:
Mailing address:
  • Phone: 760-707-9119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT161116
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: