Healthcare Provider Details

I. General information

NPI: 1417283508
Provider Name (Legal Business Name): JESSICA M ZAVALA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2009
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 E 77TH ST
NEW YORK NY
10075-1912
US

IV. Provider business mailing address

7307 CAMELLIA AVE
NORTH HOLLYWOOD CA
91605-3904
US

V. Phone/Fax

Practice location:
  • Phone: 646-687-7600
  • Fax:
Mailing address:
  • Phone: 818-915-1553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20627
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number032009
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: