Healthcare Provider Details

I. General information

NPI: 1134927148
Provider Name (Legal Business Name): VIRIDIANA ZAVALA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6161 SANTA MONICA BLVD STE 304
LOS ANGELES CA
90038-4411
US

IV. Provider business mailing address

7063 FULTON AVE APT 4
NORTH HOLLYWOOD CA
91605-4432
US

V. Phone/Fax

Practice location:
  • Phone: 213-262-6848
  • Fax:
Mailing address:
  • Phone: 818-927-7191
  • 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: