Basic Information
| Provider Information | |||||||||
| NPI: | 1275943557 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZAYAS | ||||||||
| FirstName: | MARIO | ||||||||
| MiddleName: | ESTEBAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2212 CORTE ANACAPA | ||||||||
| Address2: | |||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919144469 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195872225 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3025 BEYER BLVD STE E-101 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921543432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194285533 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2014 | ||||||||
| LastUpdateDate: | 10/09/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 89410 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 390200000X | E1273215 | CA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.