Healthcare Provider Details

I. General information

NPI: 1053405795
Provider Name (Legal Business Name): NATALIE MARIE ZAVALA MS, MFT INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 S HARBOR BLVD SUITE 200
SANTA ANA CA
92704-6823
US

IV. Provider business mailing address

1521 SHERWOOD VILLAGE CIR
PLACENTIA CA
92870-3105
US

V. Phone/Fax

Practice location:
  • Phone: 714-966-8684
  • Fax:
Mailing address:
  • Phone: 714-996-1309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF 44459
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: