Healthcare Provider Details

I. General information

NPI: 1376131839
Provider Name (Legal Business Name): HOLLY CHRISTINE ZAVALETA CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2021
Last Update Date: 01/08/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1291 SANGUINETTI RD
SONORA CA
95370-6215
US

IV. Provider business mailing address

971 FEATHER DR PMB 35
COPPEROPOLIS CA
95228
US

V. Phone/Fax

Practice location:
  • Phone: 209-533-7812
  • Fax:
Mailing address:
  • Phone: 209-817-4298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: