Provider Demographics
NPI:1609603679
Name:WANSLEY, ZYRA S
Entity type:Individual
Prefix:
First Name:ZYRA
Middle Name:S
Last Name:WANSLEY
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 1:4755 HOME AVE APT 31
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-4448
Mailing Address - Country:US
Mailing Address - Phone:917-456-5335
Mailing Address - Fax:
Practice Address - Street 1:2423 HOOVER AVE
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-6619
Practice Address - Country:US
Practice Address - Phone:917-456-5335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician