Healthcare Provider Details

I. General information

NPI: 1225780158
Provider Name (Legal Business Name): BRITTNEY DIANE-HOPE ZAVALA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2022
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2263 E ROOSEVELT ST APT 4
STOCKTON CA
95205-3851
US

IV. Provider business mailing address

2291 W MARCH LN # B103
STOCKTON CA
95207-6652
US

V. Phone/Fax

Practice location:
  • Phone: 209-594-7125
  • Fax:
Mailing address:
  • Phone: 916-729-3098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: