Provider Demographics
NPI:1043729080
Name:ZABALA, GEORGE
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:ZABALA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GEORGE
Other - Middle Name:
Other - Last Name:ZABALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCABA
Mailing Address - Street 1:30250 SOUTHWELL LN
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-5926
Mailing Address - Country:US
Mailing Address - Phone:813-838-2017
Mailing Address - Fax:
Practice Address - Street 1:30250 SOUTHWELL LN
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-5926
Practice Address - Country:US
Practice Address - Phone:813-838-2017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst