Healthcare Provider Details

I. General information

NPI: 1295565133
Provider Name (Legal Business Name): GUADALUPE ZAVALA MEYER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7245 W POTOMAC DR
BOISE ID
83704-9150
US

IV. Provider business mailing address

6125 W DENTON ST
BOISE ID
83704-9325
US

V. Phone/Fax

Practice location:
  • Phone: 208-615-9828
  • Fax:
Mailing address:
  • Phone: 208-515-9686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4061576
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: