Healthcare Provider Details

I. General information

NPI: 1821534264
Provider Name (Legal Business Name): CHRISTINE ZAVALA CCAPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 03/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 CHURCH LN
SAN PABLO CA
94806-3707
US

IV. Provider business mailing address

1901 CHURCH LN
SAN PABLO CA
94806-3707
US

V. Phone/Fax

Practice location:
  • Phone: 510-236-3134
  • Fax: 510-236-5150
Mailing address:
  • Phone: 510-236-3134
  • Fax: 510-236-5150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1236771116
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: