Provider Demographics
NPI:1801272349
Name:ZAVERAL, JERILYN (RADT-I)
Entity type:Individual
Prefix:
First Name:JERILYN
Middle Name:
Last Name:ZAVERAL
Suffix:
Gender:F
Credentials:RADT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 N SONORA AVE STE 113A
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-3966
Mailing Address - Country:US
Mailing Address - Phone:559-276-7558
Mailing Address - Fax:559-276-7568
Practice Address - Street 1:4705 N SONORA AVE STE 113A
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-3966
Practice Address - Country:US
Practice Address - Phone:559-276-7558
Practice Address - Fax:559-276-7568
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1195760315101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA106208OtherCALIFORNIA DEPARTMENT OF HEALTH SERVICES