Provider Demographics
NPI:1114530144
Name:ZAVALA, SAMUEL (ACSW)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:ZAVALA
Suffix:
Gender:M
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2268 DELTA AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90810-3530
Mailing Address - Country:US
Mailing Address - Phone:562-507-6560
Mailing Address - Fax:
Practice Address - Street 1:5000 BIRCH ST STE 3000
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2140
Practice Address - Country:US
Practice Address - Phone:877-421-1711
Practice Address - Fax:949-576-3913
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA965391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical