Provider Demographics
NPI:1497348296
Name:ZAVALA MALLA, MARIA FERNANDA
Entity Type:Individual
Prefix:
First Name:MARIA FERNANDA
Middle Name:
Last Name:ZAVALA MALLA
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 1:428 ACACIA TREE WAY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-3684
Mailing Address - Country:US
Mailing Address - Phone:318-564-4323
Mailing Address - Fax:
Practice Address - Street 1:1820 ARMSTRONG BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-2589
Practice Address - Country:US
Practice Address - Phone:407-599-4854
Practice Address - Fax:321-332-7799
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician