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General NPI Number Information
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NPI Number | 1811723752
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Entity Type | Individual
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Provider Name | JESSICA ZAVALA
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Gender | Female
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Dates
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Enumeration Date | 09/09/2024
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 404 E 4500 S STE A34
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City | MURRAY
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State | UT
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Zip | 84107-2710
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Country | US
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Telephone | 801-771-0273
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Fax |
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Provider Business Mailing Address
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Address Line | 4643 S BEECHWOOD RD
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City | TAYLORSVILLE
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State | UT
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Zip | 84123-3149
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-24-390701
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License Number State | UT
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