Healthcare Provider Details

I. General information

NPI: 1225998453
Provider Name (Legal Business Name): KLARISSA A ZAVALA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2025
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 KIMBALL AVE APT B
SEASIDE CA
93955-5949
US

IV. Provider business mailing address

1165 KIMBALL AVE APT B
SEASIDE CA
93955-5949
US

V. Phone/Fax

Practice location:
  • Phone: 831-402-0081
  • Fax:
Mailing address:
  • Phone: 831-402-0081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: