Provider Demographics
NPI:1275328684
Name:ZAVALA, ROBERTO I
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:ZAVALA
Suffix:I
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 TROWBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-5325
Mailing Address - Country:US
Mailing Address - Phone:707-558-5068
Mailing Address - Fax:
Practice Address - Street 1:817 TROWBRIDGE ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-5325
Practice Address - Country:US
Practice Address - Phone:707-558-5068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician