Healthcare Provider Details

I. General information

NPI: 1245803600
Provider Name (Legal Business Name): ICELA ZAVALA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2021
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 MARKET ST
RIVERSIDE CA
92501-1720
US

IV. Provider business mailing address

1950 MARKET ST
RIVERSIDE CA
92501-1720
US

V. Phone/Fax

Practice location:
  • Phone: 951-530-5900
  • Fax: 951-530-5945
Mailing address:
  • Phone: 951-530-5900
  • Fax: 951-530-5945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: