Provider Demographics
NPI:1083190185
Name:ZAYAS, FAUSTINO JONATHAN (PSYCHOLOGICAL ASSOCI)
Entity Type:Individual
Prefix:
First Name:FAUSTINO
Middle Name:JONATHAN
Last Name:ZAYAS
Suffix:
Gender:M
Credentials:PSYCHOLOGICAL ASSOCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4928 E CLINTON WAY STE 108
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-1526
Mailing Address - Country:US
Mailing Address - Phone:559-252-6844
Mailing Address - Fax:
Practice Address - Street 1:4862 E CLINTON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-2873
Practice Address - Country:US
Practice Address - Phone:559-252-2450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 103T00000X
CA107910106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist