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General NPI Number Information
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NPI Number | 1144349374
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Entity Type | Individual
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Provider Name | IMELDA ZAVALA
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Gender | Female
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 03/14/2014
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Provider Practice Location Address
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Address Line | 711 S NEW HAMPSHIRE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90005-1831
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Country | US
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Telephone | 213-385-5100
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Fax |
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Provider Business Mailing Address
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Address Line | 20825 SHEARER AVE
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City | CARSON
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State | CA
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Zip | 90745-1231
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC 51576
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License Number State | CA
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