Provider Demographics
NPI:1205712882
Name:ZAVALA, ALEXIS JEWEL
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:JEWEL
Last Name:ZAVALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 W LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURN
Mailing Address - State:OR
Mailing Address - Zip Code:97071-4327
Mailing Address - Country:US
Mailing Address - Phone:971-303-3145
Mailing Address - Fax:
Practice Address - Street 1:780 COMMERCIAL ST SE STE 202&305
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3462
Practice Address - Country:US
Practice Address - Phone:503-577-7753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program