Provider Demographics
NPI:1326727272
Name:ZAVALA, MARISA Z
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:Z
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 1:10415 SAMOLINE AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-2244
Mailing Address - Country:US
Mailing Address - Phone:562-922-4060
Mailing Address - Fax:
Practice Address - Street 1:555 PARKCENTER DR
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3521
Practice Address - Country:US
Practice Address - Phone:714-479-2471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician