Healthcare Provider Details

I. General information

NPI: 1619516473
Provider Name (Legal Business Name): ANJELICA LISSETTE ZAVALA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2019
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 SARATOGA BLVD
CORPUS CHRISTI TX
78417-3400
US

IV. Provider business mailing address

537 ROSEBERRY ST
BUDA TX
78610-3227
US

V. Phone/Fax

Practice location:
  • Phone: 361-881-4788
  • Fax:
Mailing address:
  • Phone: 361-726-7828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number40257011
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: