Healthcare Provider Details

I. General information

NPI: 1588073381
Provider Name (Legal Business Name): OLIVIA ZAVALA RICO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2014
Last Update Date: 11/15/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 ACADEMY AVE
SANGER CA
93657-2128
US

IV. Provider business mailing address

225 ACADEMY AVE
SANGER CA
93657-2128
US

V. Phone/Fax

Practice location:
  • Phone: 855-343-1057
  • Fax:
Mailing address:
  • Phone: 855-343-1057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number111054
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: