Healthcare Provider Details

I. General information

NPI: 1972048601
Provider Name (Legal Business Name): CYNTHIA MARIA ZAVALA CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 05/17/2020
Certification Date: 05/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 UNIVERSITY AVE
RIVERSIDE CA
92507-5202
US

IV. Provider business mailing address

5681 CRESTLINE PL
RANCHO CUCAMONGA CA
91739-2134
US

V. Phone/Fax

Practice location:
  • Phone: 951-213-3450
  • Fax:
Mailing address:
  • Phone: 626-347-7141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberNP95005543
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: