Provider Demographics
NPI:1437926565
Name:ZAVALLA, VERONICA ESTHER
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:ESTHER
Last Name:ZAVALLA
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 1:13881 FERN TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-7206
Mailing Address - Country:US
Mailing Address - Phone:239-990-9294
Mailing Address - Fax:
Practice Address - Street 1:13881 FERN TRAIL DR
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-7206
Practice Address - Country:US
Practice Address - Phone:239-990-9294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-293794106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician