Provider Demographics
NPI:1780163188
Name:ZAVALA, MARIEN GUADALUPE (AGAC-NP)
Entity type:Individual
Prefix:MRS
First Name:MARIEN
Middle Name:GUADALUPE
Last Name:ZAVALA
Suffix:
Gender:F
Credentials:AGAC-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2618 E ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90810-1503
Mailing Address - Country:US
Mailing Address - Phone:562-704-9893
Mailing Address - Fax:
Practice Address - Street 1:2618 E ADAMS ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90810-1503
Practice Address - Country:US
Practice Address - Phone:562-704-9893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009649363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner