Healthcare Provider Details

I. General information

NPI: 1306525423
Provider Name (Legal Business Name): NICHOLAS ANTHONY ZAVALA BA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 07/17/2023
Certification Date: 07/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 CARSON ST
HOT SPRINGS AR
71901-6852
US

IV. Provider business mailing address

5 CORTEZ WAY
HOT SPRINGS VILLAGE AR
71909-3735
US

V. Phone/Fax

Practice location:
  • Phone: 501-624-6468
  • Fax:
Mailing address:
  • Phone: 909-680-8229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: