Healthcare Provider Details

I. General information

NPI: 1972791622
Provider Name (Legal Business Name): MARY WASSEL ZAVALA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WILSHIRE BLVD
LOS ANGELES CA
90017-1908
US

IV. Provider business mailing address

3375 MANNING AVE #3
LOS ANGELES CA
90064-4869
US

V. Phone/Fax

Practice location:
  • Phone: 213-481-1374
  • Fax:
Mailing address:
  • Phone: 310-204-4119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: