Provider Demographics
NPI:1679991400
Name:ZAVALA, MARIA DOLORES (OTR/L)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:DOLORES
Last Name:ZAVALA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:DOLORES
Other - Last Name:ZAVALA LOPEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:88 N JACKSON AVE UNIT 126
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-3469
Mailing Address - Country:US
Mailing Address - Phone:408-644-0203
Mailing Address - Fax:
Practice Address - Street 1:88 N JACKSON AVE UNIT 126
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-3469
Practice Address - Country:US
Practice Address - Phone:408-644-0203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-29
Last Update Date:2014-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10266172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker