Provider Demographics
NPI:1003160011
Name:ZALDIVAR, FERNANDO JOSE II
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:JOSE
Last Name:ZALDIVAR
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 W RIVERSIDE AVE STE 4691
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0580
Mailing Address - Country:US
Mailing Address - Phone:360-605-0163
Mailing Address - Fax:855-959-2451
Practice Address - Street 1:522 W RIVERSIDE AVE STE 4691
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0580
Practice Address - Country:US
Practice Address - Phone:360-605-0163
Practice Address - Fax:855-959-2451
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician