Healthcare Provider Details

I. General information

NPI: 1467739565
Provider Name (Legal Business Name): MARIA A ZAVALA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 09/06/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9240 OLD REDWOOD HWY #268
SANTA ROSA CA
95407-8113
US

IV. Provider business mailing address

P O BOX 1128
WINDSOR CA
95492
US

V. Phone/Fax

Practice location:
  • Phone: 707-404-3020
  • Fax:
Mailing address:
  • Phone: 707-888-6498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: