Provider Demographics
NPI:1295358786
Name:ZAVALA, VANESSA NA
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:NA
Last Name:ZAVALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29019 CARILLO CT
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-6501
Mailing Address - Country:US
Mailing Address - Phone:951-488-0611
Mailing Address - Fax:
Practice Address - Street 1:29019 CARILLO CT
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-6501
Practice Address - Country:US
Practice Address - Phone:951-488-0611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator