Healthcare Provider Details

I. General information

NPI: 1083257703
Provider Name (Legal Business Name): COLBY ZAVALA CADC-I
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2019
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N 9TH ST STE A
MODESTO CA
95350-5814
US

IV. Provider business mailing address

2700 MACDOUGAL ST APT 23
MODESTO CA
95350-2340
US

V. Phone/Fax

Practice location:
  • Phone: 209-552-2763
  • Fax:
Mailing address:
  • Phone: 209-818-3528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCI37650223
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License NumberCI37650223
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: