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General NPI Number Information
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NPI Number | 1992434468
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Entity Type | Individual
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Provider Name | JAQUELINE ZAVALA
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Gender | Female
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Dates
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Enumeration Date | 06/08/2022
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Last Update Date | 09/04/2024
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Provider Practice Location Address
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Address Line | 1520 N RAYMOND AVE # 2-7
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City | PASADENA
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State | CA
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Zip | 91103-1819
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Country | US
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Telephone | 626-396-5920
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Fax |
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Provider Business Mailing Address
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Address Line | 456 E ORANGE GROVE BLVD UNIT 302
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City | PASADENA
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State | CA
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Zip | 91104-5237
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ASW116145
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | ASW116145
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License Number State | CA
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