Healthcare Provider Details

I. General information

NPI: 1427738582
Provider Name (Legal Business Name): MAIRA ALEJANDRA ZAVALA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12240 HESPERIA RD
VICTORVILLE CA
92395-8309
US

IV. Provider business mailing address

1020 N PALM AVE
HEMET CA
92543-3747
US

V. Phone/Fax

Practice location:
  • Phone: 760-245-8837
  • Fax:
Mailing address:
  • Phone: 951-303-4470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT162122
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: