Healthcare Provider Details

I. General information

NPI: 1568349231
Provider Name (Legal Business Name): DAVID ZAVALA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2025
Last Update Date: 08/16/2025
Certification Date: 08/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 DENNERY RD STE 301
SAN DIEGO CA
92154-8455
US

IV. Provider business mailing address

601 TELEGRAPH CANYON RD APT 153
CHULA VISTA CA
91910-6565
US

V. Phone/Fax

Practice location:
  • Phone: 619-859-4501
  • Fax:
Mailing address:
  • Phone: 208-867-1627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number52074
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: