Individual provider Active NPI

Desiree Maria Zavala, DPT

  • Physical Therapist
  • Los Angeles, CA
National Provider Identifier
1043440597
Registry record updated Oct 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
6041 Cadillac Ave
Los Angeles, CA 90034-1702
Phone
(323) 857-2458
NPI assigned
Jul 17, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 7, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

6041 Cadillac Ave
Los Angeles, CA 90034-1702

Mailing address

11126 National Blvd Apt 6
Los Angeles, CA 90064-4084
Phone (760) 912-1339

Other names 1

  • Desiree Maria Stiber Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100519000495 CA Practitioner - Physical Therapist in Private Practice 8325177009 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
35827CAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Aug 11, 2009 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Aug 11, 2009 Accepting new patients
Southern California Permanente Medical Group CurrentSince Aug 19, 2010 Accepting new patients

Locations

9961 Sierra Ave
Fontana, CA 92335
Phone (909) 427-3910

6041 Cadillac Ave
Los Angeles, CA 90034
Phone (323) 857-2000

393 E Walnut St
Unit 3RD
Pasadena, CA 91188
Phone (626) 405-7914

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1247788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633564800000",
    "number": "1043440597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11126 NATIONAL BLVD APT 6",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900644084",
            "telephone_number": "760-912-1339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6041 CADILLAC AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900341702",
            "telephone_number": "323-857-2458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZAVALA",
        "first_name": "DESIREE",
        "middle_name": "MARIA",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-07-17",
        "last_updated": "2021-10-07",
        "certification_date": "2021-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "9961 Sierra Ave",
            "city": "Fontana",
            "state": "CA",
            "country_code": "US",
            "postal_code": "923356720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "DESIREE",
            "last_name": "STIBER",
            "middle_name": "MARIA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.