Healthcare Provider Details

I. General information

NPI: 1376291716
Provider Name (Legal Business Name): MICHAELA CECILIA ZAVALA ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 S WINCHESTER BLVD STE J218
SAN JOSE CA
95128-3919
US

IV. Provider business mailing address

2329 SAIDEL DR APT 2
SAN JOSE CA
95124-4240
US

V. Phone/Fax

Practice location:
  • Phone: 408-874-6506
  • Fax:
Mailing address:
  • Phone: 650-224-5002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW106318
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: