MEDICARE: FERNANDO JOSE ZALDIVAR II

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1003160011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FERNANDO JOSE ZALDIVAR II

Provider Business Mailing Address
First Line	:	522 W RIVERSIDE AVE STE 4691
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-0580
Country	:	US
Telephone Number	:	360-605-0163
Fax Number	:	855-959-2451

Provider Business Practice Location Address
First Line	:	522 W RIVERSIDE AVE STE 4691
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-0580
Country	:	US
Telephone Number	:	360-605-0163
Fax Number	:	855-959-2451

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2012
Last Update Date	:	09/11/2025

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