Active NPI
Samuel Zavala, ACSW
- Clinical Social Worker
- Newport Beach, CA
National Provider Identifier
1114530144
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 96539
- Practice address
- 5000 Birch St Ste 3000
Newport Beach, CA 92660-2140 - Phone
- (877) 421-1711
- Fax
- (949) 576-3913
- NPI assigned
- Aug 28, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 96539 | CA | Primary |
Addresses
Primary practice location
5000 Birch St Ste 3000
Newport Beach, CA 92660-2140
Mailing address
2268 Delta Ave
Long Beach, CA 90810-3530
Phone (562) 507-6560
Other practice location 1
180 E Main St Ste 203
Tustin, CA 92780-4414
Phone (877) 421-1711
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 96539 | CA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Serene Health | Clinical | Past | Accepting new patients |
Organizations & group practices 1
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": "1598572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682035200000",
"number": "1114530144",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2268 DELTA AVE",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908103530",
"telephone_number": "562-507-6560"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5000 BIRCH ST STE 3000",
"city": "NEWPORT BEACH",
"state": "CA",
"postal_code": "926602140",
"telephone_number": "877-421-1711",
"fax_number": "949-576-3913"
}
],
"practiceLocations": [
{
"address_1": "180 E Main St Ste 203",
"address_purpose": "LOCATION",
"city": "Tustin",
"state": "CA",
"postal_code": "927804414",
"country_code": "US",
"telephone_number": "877-421-1711",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ZAVALA",
"first_name": "SAMUEL",
"credential": "ACSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-08-28",
"last_updated": "2023-04-21",
"certification_date": "2023-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "96539",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newport Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.