Healthcare Provider Details

I. General information

NPI: 1447936430
Provider Name (Legal Business Name): TANIA GUADALUPE ZAVALETA REYES ASW132941
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 SAN CARLOS AVE
SAN CARLOS CA
94070-2317
US

IV. Provider business mailing address

3100 EDISON WAY
REDWOOD CITY CA
94063-3812
US

V. Phone/Fax

Practice location:
  • Phone: 650-394-5155
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW132941
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: