Healthcare Provider Details

I. General information

NPI: 1548070899
Provider Name (Legal Business Name): LILIANA ZAVALA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43585 MONTEREY AVE STE 1
PALM DESERT CA
92260-9398
US

IV. Provider business mailing address

PO BOX 6801
LA QUINTA CA
92248-6801
US

V. Phone/Fax

Practice location:
  • Phone: 760-777-7720
  • Fax:
Mailing address:
  • Phone: 760-698-4192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number17871
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number17871
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: