Provider Demographics
NPI:1326698788
Name:ZAVALA, SERGIO I
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:
Last Name:ZAVALA
Suffix:I
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 1:7030 ALEXANDRIA-JACKSONVILLE HWY APT 45
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265
Mailing Address - Country:US
Mailing Address - Phone:256-572-9584
Mailing Address - Fax:
Practice Address - Street 1:200 CAHABA PARK CIR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-5002
Practice Address - Country:US
Practice Address - Phone:205-253-6903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-20-43293103K00000X
RBT-19-99002106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician