Healthcare Provider Details

I. General information

NPI: 1720953755
Provider Name (Legal Business Name): LILIANA ZAVALA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2025
Last Update Date: 10/08/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 N CALIFORNIA AVE
CHICAGO IL
60625-7014
US

IV. Provider business mailing address

5215 N CALIFORNIA AVE
CHICAGO IL
60625-7014
US

V. Phone/Fax

Practice location:
  • Phone: 773-561-5809
  • Fax:
Mailing address:
  • Phone: 773-561-5809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.030090
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: