Healthcare Provider Details

I. General information

NPI: 1619580396
Provider Name (Legal Business Name): MS. MELISSA ZAVALA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 07/31/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65278 DONOVAN CIR
MECCA CA
92254-7226
US

IV. Provider business mailing address

65278 DONOVAN CIR
MECCA CA
92254-7226
US

V. Phone/Fax

Practice location:
  • Phone: 760-863-9949
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: