Healthcare Provider Details

I. General information

NPI: 1487332698
Provider Name (Legal Business Name): MIKAELA ZAVALA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2023
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 GATEWAY PL STE 230E
SAN JOSE CA
95110-3719
US

IV. Provider business mailing address

2001 GATEWAY PL STE 230E
SAN JOSE CA
95110-3719
US

V. Phone/Fax

Practice location:
  • Phone: 831-809-8642
  • Fax:
Mailing address:
  • Phone: 831-809-8642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: